You have to consult a Clinical Psychiatrist.
It is a good idea to have some basic knowledge of depression before going to meet the doctor.
Clinical depression is a state of sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living. Although a low mood or state of dejection that does not affect functioning is often referred to as depression, clinical depression is a medical diagnosis and is different from the everyday meaning of "being depressed".
Symptoms:
One of the following two elements must be present for a period of at least two weeks:
Depressed mood, or
Anhedonia
It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period.
These include:
Feelings of overwhelming sadness or fear or the seeming inability to feel emotion (emptiness).
A decrease in the amount of interest or pleasure in all, or almost all, activities of the day, nearly every day.
Changing appetite and marked weight gain or loss.
Disturbed sleep patterns, such as insomnia, loss of REM sleep, or excessive sleep (Hypersomnia).
Psychomotor agitation or retardation nearly every day.
Fatigue, mental or physical, also loss of energy.
Intense feelings of guilt, helplessness, hopelessness, worthlessness, isolation/lonliness, anxiety, and/or fear.
Trouble concentrating or making decisions or a generalized slowing and obtunding of cognition, including memory.
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.
Feeling of being abandoned by those close to you.
Other symptoms reported but not usually taken into account in diagnosis include:
A decrease in self-esteem.
Inattention to personal hygiene.
Sensitivity to noise.
Physical aches and pains, and the belief these may be signs of serious illness.
Fear of 'going mad'.
Change in perception of time.
Periods of sobbing.
Possible behavioral changes, such as aggression and/or irritability.
Treatment of depression varies broadly and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically used in conjunction: medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT), may be used when chemical treatment fails.
Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements.
The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.
Although treatment is generally effective, in some cases the condition does not respond. Treatment-resistant depression warrants a full assessment, which may lead to the addition of psychotherapy, higher medication dosages, changes of medication or combination therapy, a trial of ECT/electroshock, or even a change in the diagnosis, with subsequent treatment changes. Although this process helps many, some people's symptoms continue unabated.
In emergencies, psychiatric hospitalization is used simply to keep suicidal people safe until they cease to be dangers to themselves. Another treatment program is partial hospitalization, in which the patient sleeps at home but spends the day, either five or seven days a week, in a psychiatric hospital setting in intense treatment. This treatment usually involves group therapy, individual therapy, psychopharmacology, and academics (in child and adolescent programs).
Medication that relieves the symptoms of depression has been available for several decades. These drugs are listed in order of historical development. Typical first-line therapy for depression is the use of an SSRI, such as sertraline (Zoloft).
Monoamine oxidase inhibitors (MAOIs) such as Nardil may be used if other antidepressant medications are ineffective. Because there are potentially fatal interactions between this class of medication and certain foods and drugs, they are rarely prescribed anymore. MAOI's are used to block the enzyme monoamine oxidase which breaks down neurotransmitters such as serotonin and norepinephrine. MAOI's are as effective as tricyclics, if not slightly more effective. A new MAOI has recently been introduced. Moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase A (RIMA), follows a very specific chemical pathway and does not require a special diet.
Tricyclic antidepressants are the oldest and include such medications as amitriptyline and desipramine. Tricyclics block the reuptake of certain neurotransmitters such as norepinephrine and serotonin. They are used less commonly now because of their side effects, which include increased heart rate, drowsiness, dry mouth,constipation, urinary retention, blurred vision,dizziness, confusion, and sexual dysfunction. Most importantly, they have a high potential to be lethal in moderate overdose. However, tricyclic antidepressants are still used because of their high potency, especially in severe cases of clinical depression.
Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressant considered to be the current standard of drug treatment. It is thought that one cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively, although two researchers recently demonstrated that this is a marketing technique rather than a scientific portrayal of how the drugs actually work. Recent research indicates that these drugs may interact with transcription factors known as "clock genes", which may be important for the addictive properties of drugs of abuse and possibly in obesity.
This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent.
Norepinephrine reuptake inhibitors such as reboxetine (Edronax) act via norepinephrine (also known as noradrenaline). NeRIs are thought to have a positive effect on concentration and motivation in particular.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of antidepressant that works on both noradrenaline and serotonin. They typically have similar side effects to the SSRIs, although there may be a withdrawal syndrome on discontinuation that may necessitate dosage tapering.
5-HTP supplements are claimed to provide more raw material to the body's natural serotonin production process. There is a reasonable indication that 5-HTP may not be effective for those who haven't already responded well to an SSRI.
S-adenosyl methionine (SAM-e) is a derivative of the amino acid methionine that is found throughout the human body, where it acts as a methyl donor and participates in other biochemical reactions. It is available as a prescription antidepressant in Europe and an over-the-counter dietary supplement in the United States. Clinical trials have shown SAM-e to be as effective as standard antidepressant medication, with many fewer side effects. Its mode of action is unknown.
Omega-3 fatty acids (found naturally in oily fish, flax seeds, hemp seeds, walnuts, and canola oil) have also been found to be effective when used as a dietary supplement (although only fish-based omega-3 fatty acids have shown antidepressant efficacy.
Meet the doctor and if you decide to start an antidepressant I will recommend Bupropion XL instead of SSRIs. All SSRIs cause Sexual Dysfunction and Weight gain. Bupropion XL has equal efficacy compared to SSRIs and has a better side effect profile.
2006-09-28 23:08:49
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answer #1
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answered by Ajeesh Kumar 4
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