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.

? 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

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.

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

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

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

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

It is unfortunate that these drugs are called antidepressants. They can be used very effectively for many other symptoms and disorders. The list below gives some of the treatment options for the newest antidepressants.

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SSRI’s – Effexor XR(at 37.5-75mg), Zoloft, Prozac, Paxil, Celexa, Lexapro
Non-melancholic depression, OCD, PTSD, panic disorder, premature ejaculation, social anxiety disorder, PMDD, irritability

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Wellbutrin SR
Depression with low interest, mental energy, motivation and pleasure; smokers, weight gain, low libido, delayed orgasm

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Remeron
Mixed depression, insomnia, underweight

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Effexor XR (at 150-225mg)
Melancholic depression, excessive worry and
anxiety (GAD), irritability, chronic pain, ADHD

Medication has shown in studies to always be the first line treatment for moderate to severe depression. For mild to moderate depression therapy can be beneficial. Therapy and healthy stress management (especially aerobic exercise) combined with medication can often make a dramatic difference in the outcome of treatment.
Three types of therapy have shown to be useful:
Cognitive – Helps correct distorted thoughts and attitudes that are hindering change. Negative and exaggerated thinking often make depression worse.
Interpersonal – A structured treatment that deals with improving relationships. The depressed person often withdraws from others, causing social and personal impairment. Self-esteem is also addressed.
Behavioral – Many depressed people have developed patterns of behavior that need to be acknowledged and changed. When this occurs, the positive reinforcement that results often helps encourage change and lessens the depression.