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Psychology Session

Depression

The darkness of depression descends on the afflicted individual like a thick dark cloud, isolating them from the reality they once knew.

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While in the throes of a major depressive event, feelings of despair and hopelessness crowd out the remnants of former joy and pleasure, making the mere thought of happiness seem like a distant memory. The enormous energy needed to even get out of bed in the morning cannot be mustered, so solitude and inactivity become the daily reality of the depressed person.

Depression in America

Depression impacts a staggering number of people; a whopping 16.1 million adults in the U.S. suffer from this debilitating disease. At least one-third of the people who suffer from depression never seek depression treatment or the help they need, believing that it will eventually resolve on its own. Well-meaning efforts by friends and loved ones can fall flat, as they are not equipped to even begin to understand the complexities of a depressive illness. Sometimes, even, their attempts to cheer up their depressed loved one can result in that person pulling further away out of frustration and shame.

Signs of Depression

At the core of most depressive illness is a chemical imbalance in the brain. Thankfully, study after study is demonstrating that transcranial magnetic stimulation (TMS) for depression treatment can help to reset and re-balance the brain’s chemistry, offering hope to those who suffer from this often unbearable condition.

Deep Sadness

Pervasive sense of sadness, hopelessness and/or worthlessness

Low Energy

Fatigue and lethargy, sleep disturbances – either insomnia or sleeping in excess

Small Changes

Changes in eating habits, resulting in weight gain or loss

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Lack of Interest

Loss of interest in activities once enjoyed

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Mood

Irritability, anger, and agitated states

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Suicidal

Suicide ideation and preoccupation with death

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Causes of Depression

The exact cause of depression remains a mystery, but many factors have been identified that may contribute to depression.

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Depression strikes people of all races, socio-economic groups, gender, ages, and ethnicities. In recent years, teens have been particularly impacted by depression, with suicide now the third leading cause of death among young people aged 15-24. Women are twice as susceptible as men in experiencing a depressive illness. The following are just some of the possible contributors attributed to depression:

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  • Genetic and biological factors. First-degree relatives of people with severe depression are more likely to also suffer from this mental health condition than the general population.  Biologically, various areas of the brain are likely involved.  Neuroimaging of the brain of a depressed person reveals a smaller or less active amygdala, hypothalamus, and anterior cingulate cortex.

  • High stress life events. Significant events, both positive and negative, can trigger distress, including starting a new job, moving, marriage or divorce, having children, or retirement, to name a few.

  • Long-term illness. Although it is a physical illness, being bedridden or having physical activity severely limited can trigger depression.

  • Traumatic past events. Physical, emotional, or sexual abuse can contribute to a depressive illness, sometimes years after the traumatic event occurred. Being brought up in a dysfunctional home environment where addiction, neglect, or mental illness was present can also cause latent depression.

  • Being female. The reproductive and hormonal fluctuations that women experience via the menstrual cycle, pregnancy, and childbirth are key contributors to mood shifts.

  • Age. Hormonal fluctuations are more pronounced in young people, making them more vulnerable to developing a depressive disorder. Seniors may also develop depression due to the ending of their career, loneliness after the loss of a spouse, or deteriorating health.

Symptoms of Depression

Knowing what to look for is half the battle when it comes to diagnosing depression.

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A distinct change in the demeanor and habits of a loved one that lasts more than two weeks signals that something is causing them pain and distress. The primary symptoms of a depressive illness include:

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  • Anger and frustration expressed, even over seemingly small matters

  • Persistent feelings of sadness, hopelessness, and emptiness

  • Slowed thinking and movements

  • Agitation, anxiety, and restlessness

  • Loss of interest in normal activities once enjoyed, such as sports, hobbies, or sex

  • Sleep disturbances, either sleeping in excess or insomnia

  • Changes in appetite and eating habits, resulting in weight gain or loss

  • Feelings of guilt and worthlessness, feeling like a failure

  • Trouble concentrating, remembering things, or making decisions

  • Unexplained physical problems, such as headaches or back pain

  • Obsession with death and dying, or suicide attempts, or suicide

 

Children and teens may exhibit slightly different symptoms. Common signs of depression among children may include clinginess, worry, refusal to go to school, sadness, irritability, becoming underweight, and complaints of aches and pains. In teens, symptoms may include feeling negative and worthless, feeling misunderstood, extreme sensitivity, angry outbursts, eating or sleeping in excess, self-harm, avoidance of social interaction, and using drugs or alcohol.

Types of Depression

The spectrum of depressive illness includes specific traits that define the type of depression being experienced. These include:

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Major Depressive Disorder (MDD)

Major Depressive Disorder is the most common type of depression, and is also referred to as clinical depression. MDD falls within the defined FDA guidelines that allow for insurance to cover TMS for depression treatment. MDD is episodic, with each episode lasting at least two weeks, but can last months or years. MDD is frequently co-occurring with anxiety, which TMS therapy can also help to alleviate.

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Persistent Depressive Disorder (PDD)

PDD is also referred to as dysthymia or chronic depression, characterized by a continuous, but usually less severe than MDD, form of depression. Both PDD and MDD share common traits, such as both causing overall low mood and a lack of interest in hobbies and activities once enjoyed. Both can also make normal daily activities and tasks difficult to perform. Because PDD and MDD can be difficult to differentiate, those who have been diagnosed as PDD may actually satisfy the criteria for MDD, thus satisfying the insurance coverage criteria for TMS treatment. Because of this, it is important to pursue a second opinion, if necessary, in order to determine the best depression treatment plan.

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Bipolar Disorder

For years, this was more commonly known as manic depression or manic-depressive illness. That’s because it consists of the following two mood states: mania and depression. Symptoms are typically quite severe in both categories and are not to be confused with typical mood swings many people experience on a day to day basis. Bipolar disorder includes extreme lows with difficulty or inability to function, as well as extreme highs with racing thoughts or high-risk behavior. The following are the several different forms of Bipolar Disorder:

  • Bipolar I Includes manic or mixed states (depression and mania together) lasting at least 7 days and depressive episodes that occur for 2 weeks or more

  • Bipolar II Consists of what is called hypomania, episodes that are not as extreme as full-blown mania. Also includes depressive episodes

  • Bipolar Disorder Not Otherwise Specified (BP-NOS)–symptoms include mania and depression but are not as extreme or do not meet the criteria for Bipolar I or II

  • Cyclothymic Disorder—episodes of hypomania and mild depression that last for at least two years with milder symptoms than those listed above

  • Rapid-Cycling Bipolar Disorder—typically seen in people who have an earlier onset of bipolar disorder, sometimes mid to late teens, with episodes that quickly switch between mania and depression or both at the same time

 

Postpartum Depression

Postpartum depression affects 10-15% of new mothers in the 12 months following the birth of a child. Symptoms last more than two weeks and include feelings of sadness, hopelessness, and guilt. Those afflicted may feel irritated and angry, have difficulty sleeping or eating, and have problems concentrating or staying focused. Sometimes these new mothers feel disconnected and can’t seem to bond with their baby. Many who suffer from postpartum depression are reluctant to seek help, out of fear of having their child taken from them. Postpartum depression treatment can be achieved through TMS that can help ease or alleviate depression before and after pregnancy, including through the breastfeeding phase, where antidepressants would not be permitted.

 

Psychotic Depression

Also called depressive psychosis, it combines a major depressive episode (MDD or bipolar) with psychotic symptoms. The psychotic symptoms consist of delusions and/or hallucinations. Delusions include themes such as guilt, shame, punishment, and low self-esteem. The hallucinations are typically auditory, visual, olfactory, or tactile (involve the sense of touch).

 

Seasonal Affective Disorder (SAD)

To date, the cause of Seasonal Affective Disorder is unknown.  The symptoms of SAD typically begin in the fall and last through the winter months, with the most severe symptoms during the darkest months.  SAD is thought to be caused by reduced sunlight, which changes brain chemicals and leads to the depressive symptoms.  Factors such as high melatonin levels, low serotonin levels, and low levels of vitamin D are associated with the disorder.  Symptoms include fatigue, trouble concentrating, apathy, loss of interest in sex, decreased activity level, overeating, insomnia, anxiety, and crying spells.

Depression Treatment Options

Thankfully, there are several options available for depression treatment. Recognizing the ongoing symptoms and then taking the first step in meeting with a mental health professional for a thorough screening and evaluation is key. The treatment options for managing or curing a depressive illness include:

 

Medications

Medications such as antidepressants, mood stabilizers, and antipsychotic medications are typically the first line of treatment for depression.  Selective serotonin reuptake inhibitors (SSRIs) include Prozac (fluoxetine), Paxil (paroxetine), Lexapro (escitalopram), Celexa (citalopram), and Zoloft (sertraline).  Serotonin and norepinephrine reuptake inhibitors (SNRIs) include Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq or Khedezla (desvenlafaxine).  Side effects of these medications can include sleep disturbance, sexual dysfunction, headaches, weight gain, and intestinal problems.

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Psychotherapy

Professional psychological therapy can be provided by therapists, counselors, and psychologists as a method of depression treatment.  There are various approaches to psychotherapy available, but for treating depressive illnesses it has been found that cognitive behavioral therapy (CBT) is the most effective.  In addition, family or systems focused therapy or interpersonal therapy are also effective treatment modalities.  A psychiatrist provides minimal actual psychotherapy, but is licensed to prescribe proper medications, as well as to prescribe TMS or ECT therapies.

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Electroconvulsive Therapy (ECT)

ECT has been in use since the 1930s, and involves delivering electric currents into the brain with the goal of triggering short seizures.  As a result, it can be effective in causing shifts in the brain chemistry that reduce the symptoms of mental illness, including depression.  ECT has been found to be successful when other traditional depression treatment methods have failed to provide relief from symptoms. ECT is an invasive procedure that requires sedation with a general anesthesia.  Side effects can include confusion and memory loss.

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Transcranial Magnetic Stimulation (TMS)

TMS therapy has also been proven to be a highly effective therapeutic depression treatment, but with advantages over ECT. TMS involves the use of a coil to deliver electromagnetic currents through the scalp to the prefrontal cortex. TMS is noninvasive and requires no sedation or medication. The depression treatment procedure itself is easily tolerated with mild, if any, side effects. Patients are alert throughout the session and are able to return to their normal activities immediately following treatment.

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Additional Treatments and Therapies

There are various self-management strategies available to help alleviate the symptoms of depression.  These include the practice of yoga, meditation, massage, prayer, and physical exercise.  Mindfulness training has been found to help control some of the negative self-talk and anxiety related to depression.  A nutritious diet is also a key factor in attaining improved mental health.

Depression & Suicide

Depression, anxiety, and suicidal thoughts have no socioeconomic boundaries. Mental illness can affect anyone at any stage of their lives, and the effects can be as devastating as any other disease or disorder.

According to the Centers for Disease Control and Prevention (CDC), “in 2016, suicide was the tenth leading cause of death overall in the United States, claiming the lives of nearly 45,000 people” (2018). Studies have shown that 50% of people who commit suicide suffer from depression.

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One may be at risk for suicide if they start talking about:

  • Being a burden to others

  • Feeling trapped

  • Experiencing unbearable pain

  • Having no reason to live

  • Killing themselves

 

At Achieve TMS East, we understand the correlation between depression and the risk of suicide. In order to help those at risk, we believe that it is important to understand the warning signs; therefore, we would like to share The Anxiety and Depression Association of America (2018) guidelines for people at risk for suicide below:

 

Specific Behaviors to look for:

  • Increased use of alcohol or drugs

  • Looking for a way to kill themselves, such as searching online for materials or means

  • Acting recklessly

  • Withdrawing from activities

  • Isolating from family and friends

  • Sleeping too much or too little

  • Visiting or calling people to say goodbye

  • Giving away prized possessions

  • Aggression

 

People who are considering suicide often display one or more of the following moods:

  • Depression

  • Loss of interest

  • Rage

  • Irritability

  • Humiliation

  • Anxiety

 

If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. 

suicidepreventionlifeline.org

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