Nearly 10 percent of American adults -- almost 19 million people -- are depressed, according to the National Institute of Mental Health (NIMH). Depression can be inherited, or it can emerge following a traumatic life event, such as a death in the family, childbirth, or a serious illness.
Depression can vary in severity and duration. Patients with major depression may experience overwhelming sadness, hopelessness, or anger for two weeks or more. These uncontrollable feelings can get in the way of work and relationships. A milder form of depression, called dysthymia, is less life-altering, but symptoms can stick around for two years or more.
Many people with depression also suffer from generalized anxiety disorder (GAD), one of a family of anxiety disorders that includes obsessive-compulsive and posttraumatic stress disorders. Almost everyone worries from time to time, but people with GAD feel anxious for six months or more at a time. As with depression, many GAD sufferers never seek help.
"People don't know they have a real and treatable disorder," says Jerilyn Ross, President and CEO of the Anxiety Disorders Association of America. "A lot of health professionals don't recognize it, don't know the symptoms, and don't know that it's treatable."
One effective way to treat anxiety and depression is with medication. When researchers studied the brains of depressed people, they discovered an imbalance in the neurotransmitters serotonin and norepinephrine -- chemicals that facilitate communication between nerve cells in the brain.
Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) restore balance to these neurotransmitters. SSRIs are also used to treat generalized anxiety disorder, along with antianxiety drugs like clonazepam (Klonopin), Iorazepam (Ativan), and buspirone (BuSpar).
Older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) also balance out neurotransmitters, but they tend to have unpleasant side effects. Researchers are investigating new delivery systems, including a patch-release version of the MAOI selegiline, that may eliminate some of these side effects.
Ongoing studies are focusing on several new medications to treat anxiety and depression. Duloxetine, a serotonin and norepinephrine inhibitor, appears to alleviate the symptoms of depression and put patients into remission. A class of medications called corticotropin-releasing factor (CRF) antagonists block the production of a chemical in the brain that scientists believe triggers anxiety.
Medication may be used on its own, or in conjunction with psychotherapy (also called "talk therapy"). Cognitive behavioral therapy is a popular form of psychotherapy in which patients learn to identify and control the negative thoughts and behaviors that trigger their depression and anxiety.
"Both with depression and anxiety, often individuals have a distortion in their thinking about what is going on in their life," explains Reg A. Williams, Ph.D., professor at the University of Michigan School of Nursing, and adjunct clinical nurse specialist at the school's Depression Center. "Helping them to readjust that thinking can be very powerful."
About 80 percent of patients who don't respond to medication or psychotherapy find relief in a controversial treatment called electroconvulsive therapy (ECT). Electrodes attached to the patient's head deliver electrical impulses that trigger a brain seizure. The seizure works much like medication, releasing neurotransmitters in the patient's brain. But experts caution that the procedure may cause short-term memory loss.
For patients squeamish about undergoing shock therapy, magnetic therapy is a new alternative. This still investigational treatment sends powerful magnetic pulses to the brain. Unlike ECT, magnetic therapy does not appear to cause memory loss.
An epilepsy treatment is also showing promise in depression therapy. Vagal nerve stimulation (VNS) uses a pacemaker-like device to stimulate the vagus nerve, which carries messages to and from the brain. In early trials, VNS has shown good results in patients who did not respond to standard treatments.
In recent years, researchers have turned their attention to alternative therapies for depression. St. John's Wort, which has been used by Europeans for centuries, is one of the most promising candidates. Although a 2002 National Institutes of Health (NIH) study found St. John's Wort no more effective than a placebo for treating major depression, researchers say the herbal remedy still shows promise.
"The jury is out on it, but we still feel that the data are encouraging enough to not dismiss it yet," says Jonathan Alpert, M.D., Ph.D., Associate Director of the Depression Clinical and Research Program at Massachusetts General Hospital. But he cautions that St. John's Wort can have adverse interactions when taken with drugs used to treat AIDS and to stop organ rejection.
Researchers are also looking at a naturally-occurring compound in the body called S-adenosylmethione (SAMe), which builds neurotransmitters. In 1998, SAMe was released as an over-the-counter dietary supplement. Studies thus far have presented compelling evidence that SAMe has antidepressant properties.
The first step to treating depression, anxiety, or any other mental health problem, is to consult with a primary care physician or psychologist, says Alpert. A psychological evaluation can rule out a medical condition, and identify the most appropriate course of treatment.
If you would like more information on depression and anxiety disorders, please contact:
Anxiety Disorders Association of America
(240) 485-1001
http://www.adaa.org
The Center for Mental Health Services
http://www.mentalhealth.org/cmhs/
Depression and Bipolar Support Alliance
(800) 826-3632
http://www.dbsalliance.org/
National Alliance for the Mentally Ill
(800) 950-NAMI
http://ocd.nami.org/
National Mental Health Association
(800) 969-6642
http://www.nmha.org
