About Depression

What we know about depression as a disease

By Doctor Bonner

I have treated the illness of depression for over 30 years.  It may become debilitating for some people but a variety of treatments are available including TMS which offers promising results.    We also know that depression may be a complicating factor in other illnesses including heart disease (the major cause of death in the US) so it is vitally important to reach everyone at risk.

Below is information from the American Psychiatric Association website that is important to know about this disease:

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

Depression Is different from Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

  • In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
  • In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.

For some people, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression coexist, the grief is more severe and lasts longer than grief without depression. Despite some overlap between grief and depression, they are different. Distinguishing between them can help people get the help, support or treatment they need.

Risk Factors for Depression

Depression can affect anyone. Several factors can play a role in depression:

  • Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
  • Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
  • Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
  • Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

Depression Symptoms

The symptoms of depression can vary from person to person. However, depression is generally observed as being a persistent state of sadness or a loss of the ability to experience pleasure. Those experiencing depression often lose interest in everyday activities or hobbies that were once enjoyed.

According to the standard diagnosis guide (DSM-V) published by the American Psychiatric Association, depression is diagnosed when an individual is experiencing either a depressed mood or a loss of interest or pleasure plus four or more of the following symptoms during the same two-week period:

  • Significant weight loss (when not dieting) or weight gain (a change of more than five percent of body weight in a month)
  • Significant increase or decrease in appetite
  • Excessive sleepiness or insomnia
  • Agitation and restlessness
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive and inappropriate guilt nearly every day
  • Diminished ability to think, concentrate, or make decisions
  • Recurrent thoughts of death or suicide

If you feel you are experiencing any of these depression symptoms, contact your doctor and speak with them about your depression treatment options.

Treating Depression

Depression symptoms are traditionally treated with psychotherapy and antidepressant medications, and these treatments are considered the first-line treatments. Specifically in the case of antidepressants, these medications are thought to increase the levels of under-performing neurotransmitters in the brain. While these changes have a positive effect for many, medications do not work for all and even when medication does work, there can still be some serious side effects to consider.

Antidepressant medications are chemicals that are typically taken by mouth. These chemicals circulate in the bloodstream throughout the body, often resulting in unwanted side effects such as weight gain, sexual problems, upset stomach, sleepiness, and dry mouth. Even after all this, it can take days or weeks for a medication to circulate through the body and reveal whether it is effective for a patient.

More than 4 million patients do not receive adequate benefit from antidepressants and/or cannot tolerate the side effects caused by them. For these patients, alternative treatments for depression are available. These therapies have proven to work in some people that do not receive benefit from antidepressants and/or cannot tolerate the side effects caused by them. These treatments include: Transcranial Magnetic Stimulation (TMS), Electro Convulsive Therapy (ECT) and Vagus Nerve Stimulation (VNS).

Recent research into Transcranial Magnetic Stimulation (TMS) has created a new alternative treatment for depression. It is believed that by focusing electromagnetic pulses at specific regions of the brain, TMS activates and raises the levels of neurotransmitters in areas shown to be under-performing in people suffering from depression. TMS is a very promising treatment for depression and seeks to be a viable therapy for those who have not benefited from prior antidepressant medications.

Depression FAQs

Major depressive disorder is a condition which lasts two or more weeks and interferes with a person’s ability to carry out daily tasks and enjoyed activities that previously brought pleasure. This condition affects approximately 16 million American adults, or about 6.7 percent of the U.S. population age 18 and older.1

The exact cause of depression is not known, but leading research in Neuroscience points to an imbalance in the brain’s neurotransmitters as the manifestation of depression. Neurotransmitters are chemical messengers that send signals between brain cells. A person’s genetic make-up and life history may also determine a person’s tendency to become depressed.

In 2016 a study conducted by the Center for Behavioral Health Statistics and Quality reported that major depressive disorder will affect approximately 16 million American adults (about 6.7% of the US population) in a given year. 1

Yes. The National Institute of Mental Health maintains that, “Depressive illness can often interfere with normal functioning and cause pain and suffering not only to those who have the disorder, but to those who care about them. Serious depression can destroy family life as well as the life of the ill person.” A national study of depression found that nearly all the respondents who reported a major depressive disorder also reported that their social and/or work lives were negatively affected by their illness.1 In 2010, the economic burden of depression was estimated at $210 billion in the US2 and depression was the second leading cause of disability, accounting for almost 20% of all years of life lost to disability and premature death.3 Depression can also be a lethal disease. Each year in the US, over 30,000 people die by suicide, 60% of whom suffer from depression.4, 5

There is no known cure for depression but with effective treatment, many patients can remain symptom free.

There are many factors which can predispose certain people towards depression more than others. However, the exact causation between these factors and the occurrence of depression are still being researched and debated. Some of these risk factors include:

  • Suffering from certain medical illnesses such as stroke, heart attack, cancer, Parkinson’s disease, and hormonal disorders
  • Hereditary predispositions to depression passed through genes.
  • Experiencing a serious loss, difficult relationship, financial problem, or any stressful change in life pattern.
  • Taking certain medications that may increase vulnerability to depression

According to the standard diagnosis guide (DSM-V) published by the American Psychiatric Association, depression is diagnosed when an individual is experiencing either a depressed mood or a loss of interest or pleasure plus four or more of the following depression symptoms during the same two-week period:

  • Significant weight loss (when not dieting) or weight gain (a change of more than five percent of body weight in a month)
  • Significant increase or decrease in appetite
  • Excessive sleepiness or insomnia
  • Agitation and restlessness
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive and inappropriate guilt nearly every day
  • Diminished ability to think, concentrate, or make decisions
  • Recurrent thoughts of death or suicide

If you feel you are experiencing any of these depression symptoms, contact your doctor and speak with them about your depression treatment options.

Depression is most often treated with psychotherapy (talk-therapy) and antidepressant medications administered together. Although antidepressants can be effective for many patients, they do not work for everybody. Additionally, since antidepressants are typically taken by mouth, they circulate in the bloodstream throughout the body, often resulting in unwanted side effects. More than 4 million patients do not receive adequate benefit from antidepressant medications and/or cannot tolerate the side effects caused by them. For these patients, alternative treatments are available which usually involve the use of a medical device. These treatments include: transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS).

Transcranial magnetic stimulation (TMS) uses electromagnetic pulses to stimulate nerve cells in the area of the brain thought to control mood. These pulses are thought to have a positive effect on the brain’s neurotransmitters levels. Treating depression with transcranial magnetic stimulation, may provide an alternative depression treatment for those who have not benefited from prior antidepressant medication.

References:

  1. Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  2. Greenberg PE, et al. The Economic Burden of Adults With Major Depressive Disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015; 76(2):155-162.
  3. US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 310(6): 591-608, 2013.
  4. Arias E, Heron M, Xu JQ. United States life tables, 2012. National vital statistics reports; vol 65 no 8. Hyattsville, MD: National Center for Health Statistics. 2016.
  5. Courtet, P. and Lopez-Castroman, J. (2017), Antidepressants and suicide risk in depression. World Psychiatry, 16: 317-318. doi:10.1002/wps.20460

Find help in the community

Mental Health Resources

The National Alliance on Mental Illness – NAMI – Lane County Chapter provides multiple opportunities for people to attend a support group each month. You are encouraged to come to these meetings to find caring information to help you understand and cope with issues surrounding mental illnesses.

The National Alliance on Mental Illness offers easy-to-understand information about mental illnesses, mental health care, diagnosis, treatment and recovery.

The Lane County Medical Society was founded in 1889 and dedicated to bringing the highest quality medical care to the citizens of our county. LCMS is a professional membership organization for all licensed Doctors of Medicine and Doctors of Osteopathy in Lane and contiguous counties. With over 800 physician members, the Lane County Medical Society is an important advocate for physician and patient issues as well as a valuable resource for education, community service and information.

The American Psychiatric Association, founded in 1844, is the world’s largest psychiatric organization. It is a medical specialty society representing growing membership of more than 35,000 psychiatrists. Its member physicians work together to ensure humane care and effective treatment for all persons with mental disorders, including intellectual disabilities and substance use disorders. APA is the voice and conscience of modern psychiatry.

National Suicide Prevention Lifeline: 1-800-273-8255

Lifeline Chat: suicidepreventionlifeline.org

Community Mental Health Services

24-Hour Crisis Line
Whitebird Clinic
541-687-4000

Center for Community Counseling
1465 Coburg Rd., Eugene
541-344-0620

Center for Family Development
1258 High St., Eugene
541-342-8437

The Child Center
3995 Marcola Rd., Springfield
541-726-1465

Christian Family Services
2294 Oakmont Way, Eugene
541-342-2114

Crisis Response Team for Children and Adolescents
888-989-9990

Direction Service Counseling Center
576 Olive St, Eugene
541-344-7303

Lane County Behavioral Health Services
2411 Martin Luther King Jr. Blvd., Eugene
Adult 541-682-3608
Child 541-682-7575

Looking Glass
20 E. 13th Ave., Eugene
541-484-4428

Options Counseling Service
1255 Pearl St., Eugene
541-687-6983

Senior and Disabled Services
1025 Willamette St., Eugene
541-682-4038

South Lane Mental Health
410 N. 9th St., Cottage Grove
541-942-2850

Volunteers in Medicine
3321 W. 11th Ave., Eugene
541-685-1800

White Bird Clinic
341 E. 12th Ave., Eugene
541-342-8255

Community Alcohol and Drug Treatment

Addiction Counseling and Education
Eugene 541-344-2237
Springfield 541-746-4041

Prevention and Recovery NW
1188 Olive St., Eugene
541-484-9274

Serenity Lane
616 E. 16th Ave., Eugene
541-687-1110

White Bird Chrysalis Program
323 E. 12th Ave., Eugene
541-683-1641

Willamette Family Treatment Services
1420 Green Acres Rd., Eugene
541-338-9098

See if TMS is right for you

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An initial consultation will be scheduled to discuss what is troubling you and whether TMS is an appropriate treatment. At that time, you and your doctor will review your symptoms, treatment history, and possible treatment options. Read more about what to expect.

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