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(53) Depression

 What is depression? - Helen M. Farrell (Video)

 Depression Health Center

USA NATIONAL INSTITUTE OF MENTAL HEALTH - DEPRESSION

Depression53

What are emotions, and why do we have them?

No absolutely agreed on definition for emotions exists. Many dictionaries refer to “feelings” or “moods” when defining the word; this further begs the question of what they are. Scientists who attempt to study emotional phenomena characterize them in terms of their particular interest, and thus, definitions change depending on whether the scientist is studying the biological, psychological, or social basis of emotions. This, of course, further complicates the understanding of emotions.

Historically, the mind was thought to be separate from the body and part of the soul. In fact, psyche is the Greek root for “soul.” With the advent of a more scientific understanding of the brain and mind, some scientists attempt to liken the mind to software and the brain to hardware. In actuality, however, it is not quite so simple. A simultaneous change in brain activity accompanies every change in thought, feeling, perception, or action. Today, scientists increasingly appreciate the fact that no sharp demarcation exists between the brain and the mind.

Despite the fact that mind and brain are essentially unified, drawing a boundary between the two allows for practical differences between them to be conceptualized in everyday lives. For example, such a boundary permits distinction between acts and motives. Distinguishing acts from motives helps with negotiation through everyday social interactions. For example, consider the feelings generated when standing in line and having your toes stepped on.With the immediate sensation of pain comes the feelings of shock, surprise, and probably anger. The feelings experienced are immediately followed by an assessment of the person’s motives or state of mind. Action on that assessment is guided by feelings. Emotions therefore serve to engage the body to act in some manner. The manner on which an action is taken usually carries some survival value to a given individual. Thus, lack of emotions could be likened to the lack of physical pain sensation. There would be numbness to the environment and thus problems in interacting with it appropriately. Without the ability to feel anger, joy, sorrow, fear, or love, humans would be incapable of generating priorities to action. Emotions help to prioritize-to decide when to act and when not to act. Without such abilities, choosing between arrays of decisions that are confronted on a daily basis would be unfeasible.

  Words to Know

Addiction - A dependency on something that gives comfort. Usually refers to substances (legal or illegal), e.g. nicotine, alcohol, benzodiazepines, heroin, although the term is also used more loosely in connection with certain activities, e.g. gambling, overeating, workaholism, risk-taking, sexual behaviour - and even shopping. Addiction may be physical (involving your body) or psychological (involving the mind).

Affective disorder - A disturbance of emotion or mood. High, excited moods are found in manic states, and low moods are found in depressive illness. See also bipolar disorder, depression, hypomania, mania, manic depression.

Alzheimer’s disease - A progressive brain disorder, causing Dementia. This is commoner in old age and also in Down’s syndrome. It causes shrinkage and degeneration of brain tissue. The effects are increasing loss of memory and reasoning ability. Whilst there is no known cure, recently introduced drugs such as Aricept may slow the deterioration. analyst A therapist (customarily, but not always, a psychiatrist) who practises classical (psycho)analysis, as developed by Freud and his followers. Whilst this fascinating intellectual discipline was hugely influential in the birth of psychiatry and all the ‘talking treatments’, psychoanalysis plays little part nowadays in mainstream adult psychiatric treatment, not least because a course of analysis may take several years.

Anorexia nervosa - An eating disorder. Occurring mainly in adolescent girls (and less often in males), this consists of a distortion of body image so that the sufferer fears that she (or he) is unpleasantly fat. Despite all efforts at reassurance, the person will diet severely, losing over 15% of body weight and, in the case of females, periods will cease. Bulimia nervosa is a variation of anorexia. Both are serious and always warrant expert assessment.

Antidepressant - A class of drugs used to treat depression. Some types of antidepressants include tricyclics (TCAs), tetracyclics, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), noradrenaline uptake reinhibitors (NARIs).

Anxiety - The natural response to any danger, threat or stress. Helps alert us to respond actively when under pressure; but, when it occurs out of context or in an exaggerated or disordered way, it can interfere with our daily lives. Anxiety frequently coexists with depression. See also generalised anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder.

Approved Social Worker (ASW) - A social worker with training in dealing with mental illness. Will play a key part in text procedures, as the person’s representative.

Art therapist - Art therapy may be used in hospital or be provided as part of a Community Mental Health Team’s resources. Drawing, painting, or other creative activities can be enjoyed at whatever level of ability. Sometimes it is easier to put emotion into paint or clay than into words, and quite a simple painting can be a real achievement. The work produced can be a powerful expression of feeling. Art therapists use art as a medium for therapy. atypical antipsychotic drugs A group of drugs recently evolved to treat psychotic illnesses. Though more costly than older drugs, they may have fewer side-effects. Amisulpiride, clozapine, olanzepine, quetiapine, risperidone and zotepine are in this group.

Benzodiazepine - A family of minor tranquillisers. Includes Valium (diazepam), Librium (chlordiazepoxide), temazepam and nitrazepam. Effective for short-term reduction of anxiety, and as sleeping tablets. Because of their addictive potential, they are recommended only for short-term relief (2-4 weeks only) of severe, disabling or distressing anxiety or insomnia. Tolerance can even develop quicker than this, within 3-14 days of use. Withdrawal from long-term use has to be in gradual steps of perhaps one-eighth of the daily dose per fortnight. This may take from 4 weeks to 1 year.

Bipolar affective disorder - Also called manic depressive illness, bipolar disorder is a mood disorder in which spells of high excited mood (hypomania or mania) occur, as well as spells of depression. Mood-stabilising medication, including lithium and carbamazepine, helps prevent these episodes. Brain scan CT (computerised tomography) and MRI (magnetic resonance imaging) brain scans can be helpful in studying the structure of the brain and spinal cord, where injury or other disease may be present.

Bulimia nervosa - An eating disorder, involving food bingeing, then vomiting and purging, in which there are periods of feeling out of control with eating. Binges of large volumes of food occur, with attendant guilt and misery. These may be followed by vomiting and use of laxatives to try and limit the weight gained.

Chronic fatigue syndrome - A condition of ‘severe, disabling fatigue, lasting at least 6 months, that affects both physical and mental functioning, and is present most of the time’. It may be triggered in a vulnerable person by a viral infection plus life stress, and it can lead to prolonged disability. Symptoms may include poor concentration, memory loss, sore lymph glands, muscle and joint pains, poor sleep, and exhaustion after exertion. Depression is often present. Evidence shows that prolonged rest is harmful. Graded exercise programmes and cognitive behavioural therapy have the highest success rates for treatment.

Cognitive behaviour therapy - A form of psychotherapy that concentrates on a person’s current thoughts and feelings, and how we can alter the direct effects of them by practising more positive attitudes. Has been shown to be effective in various conditions

including depression.

Community Psychiatric Nurse - A psychiatric nurse who works outside hospital. May be attached to a General Practice (GP) surgery or to a Community Mental Health Team. He or she may keep in touch with a caseload of people with ongoing psychiatric problems, and some will also take on individual counselling.

Counsellor - Someone who provides counselling. May be based in a GP surgery, practise as an independent (private) practitioner, or be attached to a charitable organisation. The most experienced ones will have a qualification issued by the British Association of Counsellors and Psychotherapists (BACP).

Craving - An overwhelming desire; associated with addictions.

Delusion - A fixed, irrational belief. May be a part of a psychosis. Examples are feelings that one is being controlled by others or is being persecuted, that one has some dreadful illness, or is a famous person.

Dementia - A deteriorating illness causing loss of all mental functioning (memory, personality and thinking ability) caused by degeneration of the brain. Alzheimer’s disease is one principal cause; repeated small strokes (multi-infarct dementia syndrome, MIDS) are another.

Depot injection - Some neuroleptic medication can be given in a slow release form, perhaps every 2-4 weeks, by deep intramuscular injection. This can be much more convenient than taking tablets daily. So far the newer, atypical drugs - with fewer side-effects - are not available in depot form.

Discontinuation syndrome - Some of the SSRI antidepressant drugs are associated with a group of symptoms that can occur when tablets are stopped or decreased suddenly. The symptoms can mimic anxiety. This does not mean that the illness is recurring but that the medication should be tailed off gradually, perhaps over 3-4 weeks.

Dopamine - A neurotransmitter that has an adrenaline-like action in the central nervous system.

Drama therapy - A form of psychotherapy that enables people to act out unspoken tensions and feelings, by playing through incidents or acting in roles, and having the content reflected back to them.

DSM4 - The American Psychiatric Association has produced this national manual of definitions of psychiatric illness.

ECT (electroconvulsive therapy)- A treatment for certain types of severe depression. It involves inducing a carefully controlled seizure while the patient is deeply asleep under a brief general anaesthetic. It is highly effective and has saved many lives.

EEG (electroencephalogram) - A recording made from electrodes applied to the scalp. It shows the levels of electrical activity in the brain and is helpful in diagnosing epilepsy, as well as other organic illness.

Group therapy - A powerful type of ‘talking treatment’. In contrast to one-to-one therapy or counselling, groupwork involves a number of people meeting regularly and working together on a common problem. Strict rules about confidentiality are usually agreed upon

(‘What you hear here, stays here’). and a facilitator may be present to see fair play. Members of groups help support each other and find solutions from their own experiences to others’ problems. Alcoholics Anonymous and Narcotics Anonymous, among others, use this format with good results.

Hallucination - A disturbance of one of the senses. A perception without a stimulus. May take the form of sights (e.g. visions), sounds (e.g. voices), touch, smells or tastes. Associated with psychotic illness, and can occur with both schizophrenic and bipolar disorders, as well as drug and alcohol misuse and withdrawal.

ICD10 - The International Classification of Disease is a classification of psychiatric illnesses. Produced by the World Health Organisation, it is designed to apply to every country in every major language. Like the DSM4, it can be used to help make a clear diagnosis from a group of symptoms, and also has information on some causes of illness.

Lithium - Lithium salts are used as mood stabilisers for bipolar – and sometimes unipolar – illness. It is also used in resistant depression. It is one of the few drugs that help prevent depressive illness. Blood tests are needed regularly.

Mania - A state of high excitement, with sleeplessness, flight of ideas, overactivity, and much mental energy and drive. Delusions and hallucinations can occur. Associated with bipolar disorder. The term hypomania is used for less severe forms of mania.

MAOI (monoamine oxidase inhibitor) - A class of antidepressant. Early MAOIs had serious potential dietary interactions, and people taking these had to avoid certain foods, but the most recent version (moclobemide) is more user-friendly.

USA Mental Health Act 1983 - This Act makes provision for the care of the psychiatrically ill. It defines when and how someone may be admitted to hospital under a compulsory order (known as a ‘Section’ procedure).

MIDS (multi-infarct dementia syndrome) - A cause of dementia, following a series of small strokes. See also Alzheimer’s disease.

NARI (noradrenaline re-uptake inhibitor) - A class of antidepressants that acts by reducing the rate at which noradrenaline is removed from the synapse.

Neuroleptics - Drugs used to treat psychotic illnesses. Also helpful with extreme anxiety states, and especially useful because they are not habit forming.

Neurology - The study of diseases of the nervous system.

Neuropharmacology - The study of drugs that affect the brain and nervous system.

Neurophysiology - The study of nervous system functioning. This includes the study of EEGs, nerve conduction and muscle studies.

Neuropsychiatry - The branch of medicine that spans psychiatry and neurology.

Neurosis - A group of mental illnesses, where contact is kept with reality. Examples are neurotic depression, anxiety, phobias and obsessional states. Sufferers experience normal emotions but in an exaggerated, inappropriate, even disabling, way, causing disruption and reduced levels of functioning. Unfortunately the term ‘neurotic’ has been devalued and has become insulting in general parlance.

Neurotransmitter - Chemicals that act between the ends of the nerve cells of the brain and spinal column to send messages – either to stimulate or to reduce activity – to different organs: nerves, muscles or glandular structures. Acetylcholine, dopamine, serotonin, adrenaline, GABA and noradrenaline are some of the main types. Antidepressants act by altering their levels, i.e. by inhibiting their reuptake (as do the SSRIs) or by reducing their breakdown rates (as do the MAOIs).

Noradrenaline - One of the key neurotransmitters.

Organic illness - A mental disturbance caused by a recognizable disease process. Conditions such as uncontrolled diabetes, severe urinary or chest infections, liver failure, head injury, epilepsy and drug withdrawal can all cause mental disturbances.

Panic disorder - A form of anxiety, where the sufferer suddenly experiences overwhelming anxiety and may feel that they are dying. These panic attacks can occur on a background of continuing anxiety. Palpitations (fast heartbeat), sweating and overbreathing can occur. Relaxation training, CBT, and antidepressant treatment are all effective.

Paranoia - A form of delusion, involving feelings of persecution or jealousy. May be part of a psychosis. The term ‘paranoid personality’ is used to describe a sensitive, suspicious personality type.

Parkinson’s disease - Caused by damage to dopamine-producing cells in a specific area of the brain, Parkinson’s disease causes a progressively stiff, slow, shuffling gait, with a ‘pill-rolling’ tremor of the hands, tiny handwriting, and a featureless, unsmiling face. Treatment is by increasing dopamine levels with drugs such as levodopa. It is associated with mood disorders, and can sometimes be associated with dementia.

Phobia - An excessive, irrational fear of some specific object or situation.

Psychiatrist - A medically trained doctor who has a special interest and further training in psychiatric illnesses and in dealing with emotional and behavioural disorders.

Psychoanalyst - A therapist who practises classical analysis. Based on Freud’s theory, this can consist of regular sessions over several years. Although the traditional image of the psychiatrist includes the patient lying on Freud’s couch, analysis is no longer part of mainstream psychiatric treatment.

Psychologist - A university graduate with a degree in the study of behaviour and its mental processes. Clinical psychologists are often part of hospital or community mental health teams. They may evaluate memory, intelligence, personality and emotions. Other branches of psychology include educational and industrial psychology.

Psychosis - A mental illness in which there is a loss of contact with reality, delusions, and an inability to see this as illness. There may also be hallucinations. Psychosis may be produced by many different causes: very severe depression, part of some physical illness, bipolar disorder, schizophrenia, schizoaffective disorder, and drug or alcohol abuse.

Psychotherapist - Someone who carries out talking therapy; or any of the many types of psychotherapy. These include cognitive behavioural therapy and interpersonal therapy.

PTSD (post-traumatic stress disorder) - Exposure to a severe trauma outside normal experience, which would cause suffering in almost everybody. It causes intense fear and helplessness, with nightmares and flashbacks, sometimes triggered later by less serious upsets. It leads to overarousal and sleep disturbance, with avoidance of situations that recall the trauma. Sufferers may overuse alcohol, making symptoms worse.

PubMed - This is a World Wide Web (WWW) retrieval service developed by the US National Library of Medicine. It provides access, free of charge, to MEDLINE, a database of more than 10 million health-related scientific publications. PubMed is an easy to-use search tool for finding medical research articles that have been published in peer-reviewed journals (i.e. scrutinised by experts). Users search by entering a few key words or phrases. Search on www.ncbi.nlm.nih.gov/PubMed/

Resistant depression - Depression which fails to respond to two courses of at least 8 weeks of full doses of antidepressants taken regularly. Management may involve combinations of treatments, e.g. CBT plus medication and addressing possible triggers.

RIMA (reversible inhibition of monoamine oxidase inhibitor) - A recently developed MAOI. This antidepressant has fewer food and drug interactions than the original versions.

UKRoyal College of Psychiatrists - The academic institution that sets national standards for psychiatric training. Entrance is by examination, and members will have the letters MRCPsych after their name. This qualification enables a doctor to follow a career in psychiatry. The College publishes two journals, the Psychiatric Bulletin and the British Journal of Psychiatry.  These are accessible via PubMed.

Schizoaffective disorder - This illness involves a mixture of mood disorder plus some symptoms of schizophrenia; it has a better outcome than the latter condition.

Schizophrenia - This psychotic illness affects about 1% of the population. It varies in its severity and form. It is characterised by delusions, hallucinations (most often auditory or ‘voices’) and ideas of being controlled in mind or body.

Seasonal affective disorder (SAD) - Low moods associated with low levels of sunlight, e.g. during winter months. Light therapy may be helpful.

‘Section’ procedure -  A compulsory admission procedure under the Mental Health Act. Usually involves two doctors, and an Approved Social Worker (ASW). Can only be used where a patient is a risk to their own health or to that of someone else, owing to a mental illness.

Section 12 Doctor - A doctor with experience in the diagnosis and management of mental illness, who is approved to take part in compulsory admission procedures under the Mental Health Act.

Sedation - Relaxing or calming someone who is distressed or agitated, e.g. with medication.

Serotonin - One of the brain’s main neurotransmitter chemicals. Low levels of serotonin are associated with depression. SSRI drugs work as antidepressants by increasing brain levels of serotonin.

Social phobia - A form of anxiety disorder, involving extreme shyness, and intense difficulty with being among other people. This condition may be quite disabling, and can lead to heavy alcohol use. Treatment with cognitive behaviour therapy and SSRIs is effective.

SSRI (selective serotonin re-uptake inhibitor) - A newer class of antidepressants. Safe in overdose, and has fewer contraindications and side effects than older antidepressants (TCAs, MAOIs), although more expensive.

Stress - Any change (whether physical, psychological or social, welcome or unwelcome) that requires us to adapt. Responses to stress may be useful or unhelpful, even damaging. Life without some stress would be unimaginable.

Synapse - The gap at the end of a nerve cell, through which neurotransmitters travel, sending impulses to other nerves, muscle or gland tissuee.

Syndrome - A collection of symptoms, which together are characteristic of a particular illness.

TCAs (tricyclic antidepressants) - These older drugs are as effective as any newer ones, but have different interactions or contraindications. For example, they should be used with caution if a patient has heart disease or glaucoma.

Tolerance - The dose of certain drugs needs to be increased to obtain the same effect as time goes by. For example, the dose of sleeping tablets, such as the benzodiazepines, may need to be increased as their effect wears off.

Tranquilliser (major and minor) - Medication that calms or relaxes. ‘Minor’ tranquillisers may be helpful for anxiety and insomnia, and include the benzodiazepines. ‘Major’ tranquillisers (more often known as neuroleptics) are helpful in anxiety and also psychotic illness.

Withdrawal symptoms - Unpleasant feelings when you have to go without a particular substance. May be psychological (anxiety, irritability and poor sleep) or physical (restlessness, sweats, muscle cramps). Some substances, e.g. alcohol and benzodiazepines, can trigger fits if heavy users stop suddenly. Symptoms vary with the substance: Valium withdrawal, for example, may last over several weeks and symptoms include restlessness, broken sleep, anxiety, nightmares and, in severe cases, fits. Antidepressants do not cause withdrawal but some SSRIs need to be tailed off gradually to avoid a discontinuation syndrome.

 

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