Symptoms
Jim Henzler
etc.
Thanks to all.
LyndaNP
Hi Jim,
Welcome to ASDM.
Here are some links and some info. Please email me anytime.
Peace,
Lynda
Depression FAQ link:
http://www.faqs.org/faqs/alt-support-depression/
Depression site:
http://depression-screening.org
Depression community link:
http://community.depressionreality.com
________________________________________________________
-- Clinical Consultations on the Depressive Phase of Bipolar Disorder
Hagop
Akiskal, MD
http://www.medscape.com/medscape/cno/1999/APA/Story.cfm?story_id=646
1999 American Psychiatric Association Annual Meeting Day 1- May 17, 1999
________________________________________________________
From:
http://www.moodswing.org/bdfaq.html
Criteria for Major Depressive Episode (DSM-IV, p. 327)
A. Five (or more) of the following symptoms have been present during the
same
2-week period and represent a change from previous functioning; at least
one
of the symptoms is either (1) depressed mood or (2) loss of interest or
pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every day, as indicated by
either
subjective report (e.g., feels sad or empty) or observation made by
others
(e.g. appears tearful). Note: In children and adolescents, can be
irritable
mood.
(2) markedly diminished interest or pleasure in all, or almost all,
activities
most of the day, nearly every day (as indicated by either subjective
account
or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a
change of
more than 5% of body weight in a month), or decrease or increase in
appetite
nearly every day. Note: In children, consider failure to make expected
weight
gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed
down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which
may
be delusional) nearly every day (not merely self-reproach or guilt about
being
sick)
(8) diminished ability to think or concentrate, or indecisiveness,
nearly
every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent
suicidal
ideation without a specific plan, or a suicide attempt or a specific
plan for
committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in
social,
occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a
substance
(e.g., a drug of abuse, a medication) or a general medical condition
(e.g.,
hypothyroidism).
E. The symptoms are not better accounted for by bereavement, i.e., after
the
loss of a loved one, the symptoms persist for longer than 2 months or
are
characterized by marked functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or psychomotor
retardation.
************************************************************************
******
Well, the APA gives us a good starting point, but it all sounds sort of
clinical. Here's a more complete list of symptoms of depression that
our
readers and participants have identified:
* Reduced interest in activities
* Indecisiveness
* Feeling sad, unhappy, or blue
* Irritability
* Getting too much (hypersomnia) or too little (insomnia)
sleep.
* Loss of, concentration.
* Increased or decreased appetite
* Loss of self-esteem, such as my understanding that I suck.
* Decreased sexual desire.
* Memory problems
* Despair and hopelessness
* Suicidal thoughts.
* Reduced pleasurable feelings (anhedonia)
* Guilt feelings
* Crying uncontrollably and/or for no apparent reason.
* Feeling helpless
* Restlessness
* Feeling disorganized
* Difficulty doing things
* Lack of energy and feeling tired.
* Self-critical thoughts
* Moving and thinking slooooooowwwwwwwly.
* Feeling that one is in a stupor
*Slowed speech
* Emotional and/or physical pain.
* Hypochondriacal worries; fears or illnesses which prove to
be psychosomatic.
* Feeling dead or detached.
* Delusions of guilt or of financial poverty.
* Hallucinating.
_______________________________________________________
Depressive Illness: The Medical Facts / The Human Challenge
NDMDA Brochure
From:http://users.wantree.com.au/~fractal/fdoctr2.htm
[Finding the best treatment regimin] requires a rigorous, cooperative
effort between doctor and patient, generally involving medication
combined with psychotherapy and the support of family and friends. It is
essential that you and your doctor work diligently together to find a
treatment plan that will control your symptoms so that you have a chance
to be happy and productive. It is even more important that a diagnosis
of a depressive illness should not stun you to inaction, nor should you
allow the stigma sometimes attached to disorders of the brain to
discourage you from continuing with your treatment. Indeed, if your
doctor has told you that you have a depressive illness, you are among
the one-third of all people with the illness who are fortunate enough to
receive a proper diagnosis. Let this brochure mark the beginning of your
efforts to work with your doctor to treat and manage your condition.
What follows are the medical facts about depression and manic-depression
as well as the best advice from the perspective of a patient and a
doctor on confronting the condition.
What Are Depressive Illnesses?
Depression (also known as unipolar disorder) and manic-depressive
illness (also known as bipolar disorder) are medical illnesses involving
disruptions in brain functions. Both are classified as mood disorders
because many of their principal symptoms involve changes in patterns of
mood or emotion. Although no single pattern of symptoms fits every
person with a depressive illness, some symptoms are common to almost
everyone.Unipolar disorder is typically characterized by periods of
intense sadness (which may sometimes be paralyzing), feelings of
helplessness, hopelessness or other symptoms such as sleep problems or
loss of appetite. These periods last for weeks, perhaps even months,
during which time normal functioning is compromised. In manic-depressive
illness, people alternate between weeks or months of mania (intense
highs, racing thoughts, grandiose and unrealistic plans and ideas),
followed by even longer periods of extreme, debilitating depression.
What Causes Depressive Illness?
The direct causes of unipolar and bipolar disorder are not entirely
clear, but a number of things are known about the type of individual at
risk for developing mood disorders, and at what stages of life the risk
may be particularly high. The tendency of these illnesses to run in
families has been shown to involve a substantial genetic component;
studies of twins and adopted children, where a child whose biological
parent had the illness is raised in an adoptive family untouched by mood
disorders, have provided researchers a means of distinguishing the
influence of heredity from life events that may contribute to a
depressive illness. Scientists also have shown that an environmental
component generally involving stressful life experiences often
precipitates the onset of symptoms. Examples include the death of a
loved one, marital problems, emotional difficulty, abuse, and other
psychosocial risk factors. Often, however, symptoms appear
spontaneously, with no apparent triggering event or cause. The more
episodes you have the more likely are they to occur spontaneously.
Who Can Diagnose a Person With a Mood Disorder?
Depending on the intensity of symptoms and how closely an individual
case fits the "typical" pattern, a psychologist, social worker, or even
a well-informed friend or family member can begin to help identify
unipolar or bipolar illness. However, because depressive disorders are
medical illnesses, only a psychiatrist or other physician can make the
proper diagnosis and initiate the pharmacologic treatment that is
necessary to control the conditions.
What Medications Are Available?
Today, a vast array of treatment options makes the treatment of unipolar
and bipolar disorders one of the true success stories of contemporary
medicine. While neither condition can be cured per se, approximately 75
to 80% of all cases can be effectively treated. In the remaining 20 to
25%, the impact and duration of manic and depressive episodes can be
significantly reduced. Medication is the key for the vast majority of
people with mood disorders, with counseling being an important
adjunctive treatment. To the uninformed, medication may seem a dubious
option. Some fear that a drug will change their basic personality,
sedate them into a zombie-like state or cause them to become drug
dependent. While it is true that there are side effects to many drugs,
the benefits often far outweigh any problems. The sophisticated
medications target particular chemicals in the brain, such as serotonin
and norepinephrine, and act on different impulses and receptors to
stimulate or block the passage of these chemicals. Following is a
listing of the major categories of medication, along with a few brand
names with which you may be familiar.
Treatments for Depression
For depression, your doctor may prescribe medications known collectively
as antidepressants. The older lines of antidepressants include cyclics
(Elavil, Norpramin, Tofranil, and Pamelor) and monamine oxidase
inhibitors (MAOIs) such as Parnate and Nardil. A "second generation" of
cyclics was later developed to help those who did not respond well to
the older drugs. These atypical medications included Desyrel and
Wellbutrin. During the past several years, the selective serotonin
reuptake inhibitors (SSRIs), Prozac, Zoloft, and Paxil, have become the
first-line treatment for depression. More recently, the selective
serotonin noradrenergic reuptake inhibitors (SSNRIs), such as Effexor,
and the 5HT2 antagonist Serzone, have come into use.Your doctor will
discover that one class of medication is more effective than another
depending on your type of depression, and he or she will choose a drug
within that class which proves to have the lowest side effect profile
for you. Not everyone has the same reaction to one drug, so it may take
some time to discover the most effective--and the most
comfortable--medication for you.
Treatments for Bipolar Disorder
Compared to the available treatments for depression, there are few
medications to treat bipolar disorder. While antidepressants are
commonly used to combat episodes of depression in people with
manic-depressive illness, the manic phase is treated with mood
stabilizers. Most physicians will choose either a derivative of the
mineral lithium or a newer medication called Depakote as the initial
treatment of choice for bipolar patients. The anticonvulsant Tegretol is
also used, although further testing must be done before it can be
considered by the U.S. Food and Drug Administration (FDA) as authorized
treatment for bipolar disorder. For many years, lithium was the only
approved treatment for bipolar disorder. It has been shown to
dramatically or moderately reestablish stability and normal functioning
in approximately 60% of people with bipolar illness; however, it appears
that certain groups of patients, including those experiencing rapid
cycling and mixed mania, are less likely to respond to lithium as a
long-term maintenance treatment. Depakote, the only FDA-sanctioned
alternative since lithium, was indicated for the treatment of mania
associated with bipolar disorder in 1995. This represented new hope for
all bipolar patients who find lithium ineffective or difficult to
tolerate. Depakote's milder side-effect profile and broader spectrum of
effectiveness are added inducements for patients to remain faithful to
treatment regimens as prescribed. Other medications that a physician may
prescribe belong to the class known as anticonvulsants, which includes
Tegretol, initially developed for the treatment of seizure disorders
such as epilepsy. These medications have proven effective in controlling
the symptoms of some forms of bipolar illness, especially those that are
resistant to lithium. These medications can be used alone or in
conjunction with lithium or Depakote. Supplemental treatment of mood
disorders can include mild to strong tranquilizing medications. During
the early phase of a manic episode, it is very important to restore
normal sleep as quickly as possible. This is an appropriate indication
for the sedative properties of benzodiazepines such as Klonopin or
Ativan. Symptoms such as highly disorganized thinking, hallucinations or
catatonic behavior can be treated with neuroleptics like Risperdal and
Mellaril.
How Long Before a Medication Begins to Work?
This is one of the most difficult issues a person with a depressive
illness may face. In cases of depression, a given medication can take
two to three weeks to produce a reduction in symptoms and several weeks
longer to achieve complete relief. This can be a most trying time for a
person with depressive illness, wondering when or if treatment will
help. During this period, the help and support of family, friends,
mental health professionals, and others is crucial for bolstering one's
motivation to remain faithful to treatment as prescribed. Medication may
begin to work more quickly in cases of bipolar disorder. In some cases,
Depakote has been shown to induce syptomatic improvement in only a few
days.
What About Psychotherapy?
Because the symptoms of unipolar and bipolar disorders affect moods,
emotions and thought--and because symptoms often can be triggered by a
life crisis--it is important to be able to talk through your symptoms in
the structured professional environment provided by a therapist.
Therapy, in group settings and in family settings, can be important for
understanding the relationship challenges created by a depressive
illness. But since serious depression and manic-depressive illness
involves biochemical and physiological changes, psychotherapy by itself
is almost never a sufficient treatment.
Whom Should I Tell About My Illness?
There are no absolute answers to this question. As with any illness, the
only people who truly need to know are you and your physician. You will
find, however, especially if your symptoms are evident to others, that
friends and family can be a great source of support and
understanding--provided they know the truth. This can be especially true
of close family members, who, if they are well informed about your
condition, can work with you during difficult times to help you manage
the illness. Because there is a genetic component to depression and
manic-depressive illness, it may be that other family members will be
encouraged to seek an evaluation if they experience a pattern of mood
disturbances.
How Will These Mood Disorders Affect My Career?
People with depressive illnesses have been some of the most creative,
accomplished, and successful people in history. Peter Tchaikovsky,
Vincent van Gogh, Ernest Hemingway, Abraham Lincoln, and Virginia Woolf
are all known, or believed to have been, sufferers of major depression
or bipolar illness. However, many of the best known people with
depressive illness did not receive any form of medication during their
lifetime, and a few died by suicide. Left untreated or inappropriately
treated, the symptoms of both depression and manic-depressive illness
can diminish the ability of even the most talented people to perform a
job well over an extended period of time.This was demonstrated in a
study published in the Journal of Clinical Psychiatry which estimated
that the total economic cost of all mood disorders in 1990 was almost
$44 billion per year in the United States. Worker absenteeism and lost
productivity on the job accounted for 56% of total dollars lost by
employers. Although businesses may balk at the cost of providing
employee healthcare, the long-term benefits pay off in terms of maximum
productivity, and if at all possible, you should not let treatment costs
prevent you from seeking help. In the long run, treating your illness is
less costly, both in financial and human terms, than letting the illness
progress.
How Do I Select a Doctor?
The partnership between you and your physician is the key to successful
management of your mood disorder. And just as it is essential that you
be open and forthcoming with your doctor, it is important for your
doctor to meet your needs and expectations. That, after all, is how good
partnerships are made. Here are some serious considerations:
Is your doctor competent to prescribe and monitor the proper use of
medications?
Your doctor should have done a thorough medical evaluation before
prescribing medications. If your doctor prescribes a drug, be sure he or
she is aware of other medications you may be taking or other health
conditions you may have developed that could interfere with or be
exacerbated by an antidepressant or mood stabilizer.
Is your doctor willing to explore treatment options in order to find
the best "fit" for you?
No single approach to treatment is perfect for everyone. In the case of
medication, you need to work with your doctor to balance the side
effects of some drugs against their effectiveness for you. Similarly,
for psycho therapy, some people may benefit most from a support group
setting while others may find one-on-one therapy to be better suited to
them. It is essential that your doctor work with you to find the best
solution for you, and then monitor its success over time.
Is your doctor comfortable with the idea of you seeking a second
opinion about treatment?
Because depression and manic-depressive illness have symptoms and
challenges that are unique to each person, it may be important for you
to seek advice from more than one physician. Your doctor should
recognize this and be supportive of your decision. He or she should also
work with you to evaluate therapies recommended by other physicians you
have consulted.
Is your doctor treating "the whole person"?
Because they can affect your thoughts and behaviors, depressive
illnesses are complex conditions that will impact your personal
development, your relationship with friends and family, your employment,
and almost every aspect of your life. Both unipolar and bipolar disorder
can be associated with an increased risk for other problems, such as
substance abuse, eating disorders, and suicide. In addition to simply
prescribing medication, your doctor should recognize when it is
appropriate for you to receive other treatments, including
psychotherapy, for these related conditions.
Is your doctor understanding and caring?
When you are diagnosed with a depressive illness, there can be no more
important objective for you than to receive the right treatment as soon
as possible. If your physician, no matter how apparently qualified,
seems not to listen to you or take a genuine interest in your recovery,
he or she may not be the right doctor for you.
Is your doctor ready to work with your family and friends?
While not everyone relies on the support of family in their treatment
program, when feasible, it can be a vital component of treatment. Your
doctor needs to be prepared to help educate those closest to you about
depressive illness and explain what their roles can be in helping you
manage it.
What is a Mood Chart?
One of the most helpful tools you and your doctor will use to design
aneffective treatment plan is called a "mood chart," a chronological
record tracking the feelings and behaviors associated with your
condition. Its purpose is to let you and your doctor know the rhythms
and cycles of your illness in order to better design treatment.To use a
mood chart, you will need to begin by keeping a record of how you feel
each day. Use a diary, for example, or a small notebook with dated
pages. Each day rate your mood on a scale from 1 (worst I've ever felt)
to 10 (best I've ever felt). On the same page record other pertinent
information, including the medication you are taking and any key events
that have taken place on that day. Because a person's moods can vary
with time of day, for accuracy and continuity, try to record your mood
at approximately the same time every day.Then, each day, plot your mood
on the chart at right and connect each day'sentry by a line. Over time
the chart will provide you and your doctor a fairly objective history of
the way you have been feeling and the effectiveness of your current
treatments. Mood charting is truly valuable in our stockpile of weapons
against depressive illness.
This brochure was prepared with the assistance of Scientific Advisory
Boardmembers Frederick K. Goodwin, MD and Robert M.A. Hirschfeld, MD;
Philip Janicak, MD; National DMDA Executive Director Susan Panico; and
Gary Goldsmith.1992, rev. 1996 NDMDA
Lynda
Hopper
but with the proper prudence.
She is on the conservative side though. I think it comes from being "here"
for so long.
LyndaNP <Lyn...@bigfoot.com> wrote in message
news:4CBF2B8A4641D774.56F3D954...@lp.airnews.net...