Understanding Mental and Emotional health

When one feels down and this may happen from time to time in today’s fast paced world where family and friends rarely have time for each other. Emptiness and despair take hold of you and simply won’t be driven away then it is a sure case of depression. ‘Feeling blue’ is a term most commonly used in everyday parlance functioning even in daily activities seem a herculean task and one cannot enjoy life as one normally did. Exhaustion at all times, friends and hobbies don’t give you joy, everything seems hopeless and just the thought of getting through the day seems daunting. But there is help at hand and one must make use of support groups and individuals who can help you cope and overcome this terrible feeling. You must extend your hand and take help but before that you need to understand what depression is.

Life’s struggles are a feature in everyone’s life. Setbacks don’t choose to happen only with you and disappointments are a part of normal cycle of human existence. But these things alone which some people label as depression is not true, sadness and disappointments don’t constitute as depression. Some people who are depressed describe it as a feeling of being in a ‘black hole’. Some others feel lifeless, empty and devoid of feelings for what is happening around them. Men sometimes get aggressive, angry and violent when depressed.

Depression is different from being sad as when you are depressed it puts a halt to normal behavior- one cannot work, eat, study, sleep or have fun as one would in a normal course of a work day. The intensity and unrelenting hopelessness and worthlessness drown one’s life into a pit from where there seems to be no way out- a maze of helplessness with no door to the outside. There are a number of questions you can ask yourself for singling out symptoms of depression. One either sleeps too little or too much, previously done easy tasks are difficult now, you feel hopeless and helpless, even after trying you cannot seem to control negative thoughts, you are more than normally aggressive, irritable and short tempered, you have thoughts of life not worth living- any or most of these symptoms should immediately make you ask for help.

These symptoms may vary in degree from person to person. But the stronger and longer they have lasted means that you are heading towards a severe form of this malaise and you need to seek help as soon as possible. Depression has been seen to be a major cause of suicides. When a person even talks of suicide it may be a major cry for help. These thoughts and behavior need to be addressed immediately by those in the know of such people. Though one treatment does not fit all types of depression the most common and effective forms have been a combination of social support, lifestyle changes, emotional skill building and professional help. Managing stress, cultivating supportive relationships, practicing relaxing techniques, eating healthy, etc are all ways of combating this terrible feeling.


Women Pay Heavy Price for Alcohol Abuse

Researchers interviewed 711 St. Louis women and men who had been labeled 15 years earlier as heavy drinkers in a National Institutes of Health (news – web sites) study. The researchers found that the women, in general, were in poorer physical and mental health than the men. The women reported more difficulty with activities such as climbing stairs, walking around the neighborhood, or caring for family members.


They also had more physical disorders that forced them to either decrease the amount of time they spent at work or at social activities. And, compared with the men, they reported greater body pain and poorer mental health, including significantly higher rates of depression. “We were surprised by the magnitude of the difference between males and females,” says Kyle Grazier, author of the study and an associate professor in health management and policy at the University of Michigan School of Public Health.


Grazier presented the findings at the First World Congress on Women’s Mental Health, held in Berlin, Germany. “The heavier drinking women were much more disabled than the men,” Grazier says. “We know women are more prone to depression and mental disorders, but we didn’t expect to see the functional disorders.”


But such findings echo reports from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which show that women are more susceptible than men to alcohol-related organ damage. And women are more likely to develop alcohol-induced liver diseases, particularly cirrhosis and hepatitis, over a shorter period of time and after consuming less alcohol than men.

Types of Depression in Women During Major Life Stages

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that is characterized predominantly by mood symptoms.[31] DSM-IV includes PMDD under the category of “depressive disorders not otherwise specified.” Approximately 3% to 9% of premenopausal women experience PMDD.[32,33] Onset typically occurs during the teens to late twenties, and symptoms usually peak in one’s thirties and early forties. Past episodes and a family history of mood disorder appear to be common in women with PMDD, and these women are also at high risk for eventually developing a major depressive episode.


The course of PMDD parallels that of a recurrent major mood disorder in that it becomes more severe, extends in duration, and becomes more refractory to treatment over time.[34] The lifetime comorbidity rate ranges from 30% to 70% in PMDD patients with a history of a major depressive episode.[31] The symptoms of PMDD, as described in the DSM-IV, are shown in Table 4. There is some overlap between symptoms of a major depressive episode and PMDD, with PMDD typically mimicking an atypical form of MD. DSM-IV specifies that the diagnosis of PMDD applies only to women who have symptoms that emerge during the luteal phase (1 to 2 weeks before menstrual flow) and subside shortly after menses.


Additionally, the symptoms must cause functional impairment at work or of interpersonal relationships.[7] The etiology of PMDD is unknown, but may be related to the effects of changes in reproductive hormones during the luteal phase of the menstrual cycle on neurotransmitter, neuroendocrine, or circadian systems.[34] More specifically, changes in adrenergic-receptor binding through a precipitous decline or fluctuation in ß-endorphin levels have been correlated with symptoms of PMDD. Decreases in gamma-aminobutyric acid levels, serotonin uptake in platelets of women with premenstrual changes, and imipramine receptor binding have also been found in PMDD. Changes in these markers are also found in MD in women, which may explain the similarity of depressive symptoms between MD and PMDD.


Validated and standardized instruments to assess and diagnose PMDD include the Structured Clinical Interview for DSM-IV Depressive Disorders and the Structured Interview Guide for the Hamilton Depression Rating Scale (inclusive of items pertaining to atypical depression), the Menstrual Distress Questionnaire, the Premenstrual Affective Form, and the Calendar of Premenstrual Experiences. To confirm the diagnosis, clinicians should use patients’ self-rated symptoms of PMDD, using daily mood visual analogue scales, for two consecutive menstrual cycles. Other components of the evaluation include a physical and gynecologic examination, a thyroid function test, and measurement of the serum luteal progesterone level or urine luteal hormone surge to document ovulation.

Link between depression and women

To promote pharmacists’ understanding and recognition of major depression in women and to review gender/sex-specific differences in its prevalence, etiology, risk factors, clinical features, course, and management. Data Sources: Clinical literature on this topic in the English language since 1990, searched through MEDLINE. Study Selection: Selected review articles and clinical trials from peer-reviewed journals.


Data Synthesis: Epidemiologic data from diverse cultures indicate that the lifetime prevalence of major depression is twice as high in women as in men. The artifact, biological, and psychosocial hypotheses have each been proposed to explain the predominance of lifetime depression in women. Major depression is a multifactorial disorder and is influenced by numerous risk factors, including age, socioeconomic status, childhood history of sexual abuse, and recent stressful life events. Clinical course and presentation tend to differ between women and men.


Women may experience different types of depression during various reproductive or life stages, including premenses, pregnancy, postpartum, and menopause. Treatment for major depression includes psychosocial therapy, pharmacotherapy, and electroconvulsive therapy. The literature indicates that major depression is often under recognized and under-treated. Conclusion: Biological and psychosocial factors contribute to the higher vulnerability of women to major depression.


The biological-psychosocial origins of depression in women may require a multidimensional approach to treatment. By providing education about this disease, referring individuals with signs and symptoms of depression for evaluation, and encouraging appropriate use of antidepressants, pharmacists can improve the detection and treatment of major depression.

Gene Linked To Depression In Women

“This is a global phenomenon,” said Meana, who will address the issue at a meeting of the International Association for Women’s Mental Health in Washington this week. It is unlikely that any single gene, hormone level or type of experience explains the higher incidence of depression in women, experts say. Instead, several genes probably work in concert with the ebb and flow of reproductive hormones to change brain chemistry in ways that might set the stage for depression, especially after an emotional ordeal.


Another risk factor appears to be something that researchers call overthinking, a tendency to dwell on petty slights, to mentally replay testy encounters and to wallow in sad feelings. Studies show that this type of negative thinking is far more common in women than in men, and that it can be a harbinger of clinical depression. “The gender difference in overthinking is strongly tied to the gender difference in depression,” said Susan Nolen-Hoeksema, a professor at the University of Michigan and a leading researcher on women and depression.


About half the risk of depression is thought to be genetic. The single gene 5-HTT, which has been definitively linked to depression, is no more common in women than in men. But preliminary research suggests that there are other depression-related genes that mainly affect women. Depression is more often DIAGOSED in women and this is the ONLY fact the “experts” have. Of course there is that inconvenient truth that men commit four time as many suicides as women do, but this is a fact that the “experts” consciously choose not to “have”.


I don’t necessarily think that this is based on fact. From what I’ve also read men live longer if they’re in a stable relationship. Just as a matter of interest, divorce rates are soaring and couples who might otherwise have ‘toughed it out together’ are breaking up. Has anyone any refs or stats on ‘depression’ in single parent families and within ‘marriage’?.

Effective treatment for depression

The cocktail is diluted to 20 or 30 cc and administered by a very slow injection (1-2 cc per minute). Injections are typically given 1-2 times per week and patients can expect to feel some relief by the second week of treatment. Individuals with chronic conditions usually opt to continue receiving injections every 1-4 weeks indefinitely. Over 80% of the FMS patients that receive this treatment report that they experience pain relief. Minimal side effects have been reported with local vein discomfort topping the list. Some experience flushing due to the magnesium content and can taste a vitamin flavor directly following the injection.


Allergy to the preservative in the nutrients must be ruled out. The premise of the cocktail is that many illnesses appear with a brigade of digestive conditions in tow thus the body is unable to properly digest and extract the nutrients it desperately needs from the diet. The nutrients in the cocktail are injected therefore they bypass the digestive process and go straight to work healing what ails. Those with FMS, CFIDS, and chronic depression report feeling an energy boost lasting from days to weeks.


This is a straight forward, effective, inexpensive treatment that helps people manage their pain and acquire the nutrients that are essential to heath. “In the AFSA-funded study, the goal of the investigators is twofold: First, to see if the lack of DNIC system function in FMS patients can be used as a measure to distinguish them from healthy controls, those with depression and those with low back pain, a regional pain syndrome.


And, second, to use Effexor-XR (the extended-released version) to determine whether this drug will improve the action of the DNIC system in FMS patients as well as improve their overall functional well-being.” AFSA is a non-profit organization dedicated to research, education and patient advocacy for fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In all funded studies, patients are screened to determine if they meet the diagnostic criteria for both FMS and CFS so that conclusions can be drawn about both syndromes.

FMS versus Depression

Recurrent or persistent pain, especially with an unrecognized or incurable cause, threatens our ability to function and our sense of well-being. Many FMS patients have lost their careers, their role in the family, their capacity to think clearly, or the power to control their muscles. It is natural that such debilitation would lead to frustration and depression. In fact, if you’re experiencing these things on a daily basis, it would probably be abnormal not to be depressed. To illustrate the point that the lack of a known organic pathology does not indicate a psychological cause, Dr. Yunus has compared FMS to other diseases for which the etiology is known.


He points out that cancer is known to be exacerbated by psychological factors such as depression, anxiety, and stress. Yet no one would say that cancer is a psychological disorder. The fact that we don’t yet know the cause of FMS does not mean that it doesn’t exist, or that it is “all in your head.” Research has indicated that emotional disturbance in patients with chronic pain is more likely to be a consequence than a cause of pain. Dr. Robert Bennett, a well-known FMS researcher and clinician, points out that depressed patients who are treated for depression generally respond very well to antidepressant medications. However, patients with fibromyalgia continue to have symptoms such as pain and disordered sleep.


Examining the role of psychological factors in FMS is complicated by an inability to separate depression symptoms that may have existed before the onset of FMS from symptoms that are a result of chronic illness. But regardless of whether depression precedes or follows the onset of fibromyalgia, these symptoms are separate, and FMS symptoms will remain after the psychological symptoms are treated.


Studies have shown that as a group, fibromyalgia patients are no more depressed than other patients with chronic rheumatic diseases such as rheumatoid arthritis. One study compared the responses on a depression rating scale of 45 FMS patients, 29 rheumatoid arthritis (RA) patients, and 31 healthy controls with no pain (NC). No difference between the two illness groups was found. However, in each group a subgroup of patients appeared to be experiencing significant depressive symptoms.

Clinical demographic data for depression patients

Clinical and demographic data for all three groups are presented in Table 1. All subjects were Caucasian, and the groups were well matched in aggregate for age, gender, premorbid IQ (National Adult Reading Test; Nelson, 1982) and handedness. Healthy volunteers were clearly less fatigued than the patient groups. Median Hamilton Depression scores were highest for the depressed patients, significantly lower in the CFS patients, and lowest in healthy volunteers. Table 2 lists the peak differences in perfusion between the three diagnostic groups using SPM.


Figure 1 illustrates perfusion differences between patient groups and healthy volunteers in a slice 40 mm above the orbitomeatal line. Uptake was greater, mainly in the right thalamus (as well as pallidum and putamen), both in subjects with CFS and those with depression, than in healthy controls. CFS patients also showed increased perfusion in the left thalamus. In comparison with the CFS group, in the patients with depression perfusion was decreased in the left prefrontal cortex. The remaining foci in Fig. 1 did not achieve statistical significance at the cluster (volume) level. Table 2 Effect of diagnosis on cerebral perfusion (statistical parametric mapping analysis).


All areas containing voxels with uncorrected P < 0.001 are listed Fig. 1 Voxels with increased perfusion in patient groups, compared with healthy volunteers and with each other. The cross-point marks the peak difference: (a) chronic fatigue syndrome v. healthy volunteers; (b) depression v. healthy volunteers; (c) depression v. chronic fatigue syndrome. The results of the ROI analysis are shown in Table 3.


The pattern of results in the thalamus and putamen is similar to the patterns obtained with SPM, although the differences are non-significant, apart from in the left thalamus and right caudate and putamen in unmedicated CFS patients. The significant ROI differences in caudate nuclei could be due to the cortical rim fitting of the template, which can result in partial volume effects between central structures and ventricular cerebrospinal fluid.

Common fatigue and depression

Finally, while fatigue is common to both depression and CFS, the severity and effect of the fatigue appears to be much greater in CFS. According to research cited by Fred Friedberg and Leonard Jason in their book, Understanding Chronic Fatigue Syndrome, fully 100% of CFS patients report severe and debilitating fatigue, compared to only 28% of depressed patients. The effect of the fatigue on functioning has also been found to be significantly greater in patients with CFS than in those with clinical depression.


These and a multitude of other findings provide evidence against an explanation of CFS as a form of depressive illness. It is also important to note that a substantial proportion of CFS patients have no psychiatric disorder, yet still manifest symptoms. This suggests that CFS cannot be attributed completely to psychological factors. Addressing the Depression While depression is clearly not the cause of Chronic Fatigue Syndrome or Fibromyalgia, you should not ignore feelings of stress or depression.


They may be acting as contributing factors, as is the case in most illnesses. The good news is that depression is highly treatable, with a variety of medications that can be tailored to individual needs. Having a network of emotional support is also essential in coping with any illness, particularly one that is so complex and poorly understood.


There is so much about CFS/FMS that we cannot control. However, depression is one thing that we can do something about. Most people with chronic illness have increased feelings of sadness or hopelessness at some point; this is to be expected. Don’t suffer in silence. Reach out to others who can understand and offer help, and consider talking with your doctor about how you can address symptoms of depression together.

“It’s Not All In Your Head” CFS vs. Depression

The controversy about whether Fibromyalgia and Chronic Fatigue Syndrome are simply psychological disorders persists despite the fact that an abundance of research has shown otherwise. Last week’s article focused on the distinction between Fibromyalgia Syndrome (FMS) and depression. There is an even greater body of research that compares patients diagnosed with primary depression to those who fit the criteria for Chronic Fatigue Syndrome. According to CFS expert Dr. Anthony Komaroff of Harvard Medical School, studies of CFS patients around the world show evidence of abnormalities in the brain and immune system.


Although we still do not understand the cause of these problems in CFS patients, Komaroff points out that it is not “all in their heads.” Says Komaroff, “There is no evidence of any psychiatric disorder in a sizable number of patients with this illness.” In fact, research has distinguished between depression and CFS on both a biological and psychiatric basis. Studies of brain pathology have revealed abnormalities in patients with CFS that are not characteristic of depression. For example, a 1992 study showed that CFS patients exhibit more alpha electroencephalographic (EEG) activity during non-REM sleep.


This irregularity is not found in patients with major depressive disorders. In addition, a greater number of CFS patients (53%) report difficulty falling asleep, while this number is only 26% for depressed patients. Immunological and neurological findings also differ between CFS and depression. A 1995 study indicated that CFS patients with more severe cognitive problems exhibited more abnormalities in their immune systems. Since the study statistically controlled for depression, this finding indicates that the presence of cognitive dysfunction in CFS sufferers cannot be explained merely by depressive symptoms.