This article has been moved to a new category: Medication: Side Effects

Stress overload occurs when there is more stress than stress management in a person’s life. Anxiety and depression are a response to stress overload and stress vulnerability. The following list describes examples of life situations in each category. All change, good or bad, is a stressor. The body goes into a state of arousal when new life situations occur.
STRESS
• Pressure/Demand
• Medical illness
• Lack of control
• Conflict (work/relationships)
• Change (good or bad)
• Death
• Traffic gridlock
• Finances
STRESS MANAGEMENT
• Adequate sleep
• Enjoyable physical activities
• Being in control
• Religious activity
• Positive relationships
• Healthy diet
• Hobbies
• Healthy sex

? Anxiety disorders
• Substance abuse
• Medical disorders
• Insomnia
• Personality disorders

The goal of treating depression is full remission of symptoms. This means back to normal functioning, not just improvement. The next goal is prevention of relapse. The risk of relapse is significantly increased if treatment only results in partial recovery from symptoms. For recurring major depression, even when treated to full remission, reducing the dose of medication increases relapse.
A three year follow-up study of a group of patients showed these relapse rates:
• 20% on full dose medication
• 50% on 1/2 dose medication
• 80% on placebo

Medical treatment can be very successful. Some studies report that 70% of those adequately treated with antidepressants recover completely.
One of the keys to successful treatment is finding the right medication for the type of depression an individual has. It is also important to select an antidepressant that helps relieve symptoms of comorbid disorders, such as anxiety, insomnia, etc. After a medication has been chosen, careful monitoring of side effects and symptom improvement will help find the most effective dose for each individual. This takes patience and team effort between the doctor and patient.

? Depressed mood
• Loss of interest/pleasure
• Change in appetite or weight
• Insomnia or hypersomnia
• Fatigue
• Slowed thinking/concentration
• Feelings of guilt/worthlessness
• Suicidal thoughts
• Psychomotor agitation/slowness

Do you feel sad or down? Do you have crying spells and/or lost interest or motivation? Do you have low mental energy or lack normal enjoyment of life? If the answer is yes to any of these questions you could be depressed.
Clinical depression is not just a feeling. It is a chemical imbalance in the brain. When this occurs, transmitters and other important brain activities are significantly reduced. It is as though part of the brain has a low battery cell.
The depressed brain does not concentrate well, think clearly, or experience pleasure. A person that is clinically depressed frequently cannot project into the future to imagine ever feeling good again. Clinical depression is often the result of chronic stress overload.
Early life loss or trauma can increase vulnerability to depression. Anxiety symptoms are usually experienced prior to depression. This process can take months or even years before clinical depression develops.
Severe depression produces high levels of cortisol (the main stress hormone). Cortisol can cause loss of brain cells. Early morning awakening is probably caused by high levels of cortisol. This happens frequently with depression, making mornings especially difficult. Cortisol also suppresses immune functioning and normal body repair.
Why does one person react to stress with depression, but
others will have headaches, ulcers, or GI problems, etc.?The answer is genetics.
To find out what stress symptoms you may be vulnerable to consider these questions:
• Were your parents happy and productive?
• Are your siblings, children, and grandparents all happy, productive people? If first degree relatives react to stressors with anxiety and depression, chances are great that you will too.

Fred Goodwin, M.D., an expert on bipolar disorder, cautions that antidepressants can trigger symptoms of bipolar disorder in a person that has never had symptoms in the past.
What does this mean? When an individual goes to the doctor suffering from symptoms of depression the genes could be present for bipolar depression, not just depression. If the bipolar genes are present, initial treatment with antidepressants alone can cause symptoms of bipolar even if the patient had no symptoms in the past.
It is extremely important to give the physician a thorough family history when seeking treatment of depression for the first time. If any known relative, (parent, sibling, child, Grandparent), has had any symptoms of bipolar,
it is usually safer to treat with a mood stabilizer first, not an antidepressant.
Clues to look for in family history:
• Any extremes in mood/behavior
• Periods of extremely high productivity
• Period of low or no productivity
• Episodic alcohol/substance abuse
• Relatives that have had “nervous breakdowns” causing lost jobs, relationship problems, or hospitalization
• Dramatic changes in sleep habits (going without sleep for days or staying in bed for days at a time)
• Persons that seem normal most of the time, then suddenly become withdrawn, irritable, argumentative, or extremely talkative or aggressive
• Any suicide in the family

• 70% of persons with two bipolar parents will be bipolar
• Untreated bipolar disorder will worsen over time becoming more frequent and severe
• Bipolar often begins with depression
• Antidepressants can induce a manic response in a person that is bipolar
• Bipolar is a serious disorder with a 15% rate of suicide
• 5-8% of the population have a bipolar spectrum disorder
• The average age of onset is 15-19
• Bipolar disorder is not diagnosed on average for 9-10 years
• 20% of those with bipolar disorder have panic disorder
• 25% of those depressed are bipolar
• 48% of those with bipolar disorder consult 3 or more professionals before receiving correct diagnosis Bipolar disorder can be caused by head injury, substance abuse or genetics
• Substance abuse or dependence is more likely during mania
• 70% of bipolars that stay up all night become manic the next day

Bipolar is a lifelong disorder. At this time, there is no known medication that can cure or eliminate it. Medication only manages and controls the symptoms. Bipolar disorder must be constantly attended to just as the person with diabetes must do the things necessary to keep it under control.
Along with carefully managed medication, it is essential that a healthy lifestyle be maintained. When both of these are achieved, mood can be stabilized and a normal, stable, high functioning life is possible.

? Life charting – Construction of a graphic representation of major symptoms, major life events and treatment over the person’s lifetime. This aids in establishing the course of the disorder and the life events that contributed to mood swings.

? Mood graph – This helps to optimize medication management. A daily chart monitoring sleep, symptoms, side effects, mood changes, medications, etc. provides a valuable tool for maintaining a good treatment plan.

? Good health habits – Developing and maintaining regular patterns of daily activities helps reduce stressors that cause mood swings. It is especially important to develop regular patterns of sleep. Sleep deprivation triggers mania. However, too much sleep causes decreased mental energy and motivation.

? Involvement of a significant other – Spouses/friends can play an important role in detecting a mood swing when the impaired person may not know they have a problem (especially when manic). They can also provide encouragement for taking medication even when the bipolar person is feeling well and doesn’t think they need medication.