Saturday, March 31, 2007
I am in the process of writing the next post - on lung cancer. But to keep you occupied in the meantime I thought I'd post a link to WebMD's Symptom Checker. It's a handy tool - you can enter your symptoms and where they are, and it tells you what diseases you might have. I knew you all would enjoy it as much as I did. I just learned about a new (to me) disease called Floppy Eyelid Syndrome. Luckily it seems I don't have that.
WebMD Symptom Checker
Monday, March 19, 2007
I happened to be watching a biographical show about Eleanor Roosevelt on public television and it mentioned that her mother, Anna Hall Roosevelt, died at the tender age of 29, of diphtheria, when Eleanor was a child.
This made me think about diphtheria, one of the dread diseases of the past that in the United States has been rendered rare because of widespread vaccination. However, there are still cases of it from time to time here, and in other parts of the world it is still common, particularly in parts of the former Soviet Union, where there was a serious epidemic between 1990 and 1998 (over 150,000 cases).
My father had diphtheria when he was about six years old and, obviously, recovered. However, I wondered whether his lifelong tendency to a nervous cough may have been a leftover effect of the traumatic feeling of his throat closing off from the swelling and membranous material that diphtheria causes in the throat.
I also recall reading about diphtheria in my favorite Cherry Ames nurse books when I was young; this series was written originally in the 1940's so diphtheria was not as uncommon then as it is now (19,000 cases in 1945) so Nurse Cherry did run into it in some of her cases. The description of the symptoms left a lasting impression on me. (For those not familiar with Cherry Ames, you can read more about her here).
Diphtheria is a nasty disease, and if you aren't sure when you had your last booster shot for it, I'd recommend having one, especially if you travel to other parts of the world. It is given in conjunction with the tetanus vaccine, and it is recommended you get a booster every 10 years.
What is it?
Diphtheria is a highly contagious infectious disease that is caused by a bacterium. Unfortunately, unlike your ordinary run-of-the-mill bacterium, this one creates a toxin (similar to what happens with botulism or tetanus).
Diphtheria is quite contagious and easy to spread. People get diphtheria by breathing in diphtheria bacteria after an infected person has coughed or sneezed. People can also catch it from coming in contact with discharges from an infected person's mouth, nose, throat, or skin.
There are several kinds of diphtheria; the milder type is called Anterior Nasal Diphtheria and it mainly affects the back of the nose and doesn't tend to expose the person to a lot of the toxin.
Another common type is pharyngeal and tonsillar diphtheria. If a patient gets this type of diphtheria, a good amount of toxin is usually absorbed, which can cause serious consequences.
Laryngeal Diphtheria affects the larynx (voicebox); it is sometimes an extension of the pharyngeal type or can occur on its own.
Diptheria can also occur in the skin, called Cutaneous Diphtheria; this usually shows up as some type of ulceration or rash.
What are the symptoms?
Anterior Nasal: The symptoms mimic a common cold, but with a nasty nasal discharage and a whitish membrane that forms in between the nostrils on the "septum" that separates the insides of your nose. This sounds pretty nasty but it's not as bad as what happens with the other kinds. This type of diphtheria is pretty easily cured by administration of antibiotics and anti-toxin.
Pharyngeal/Tonsillar: This starts with a feeling of general crumminess (malaise), sore throat, lack of appetite and low grade fever. After a couple of days, a bluish grey membrane starts to form in the back of the throat. Eventually it can appear blackish if bleeding occurs. It sticks to the tissues of the throat and can't be removed without causing bleeding. It can result in obstruction of the throat and interfere with breathing. This is the criical point; at this time a patient may recover, or else develop further complications. If a large amount of toxin is absorbed,the patient can become weak, with a rapid pulse and pale skin; and can even fall into a coma. The neck can become markedly swollen due to swollen lymph nodes. Death can occur within 6-10 days if treatment is ineffective.
Laryngeal: Symptoms of this type of diphtheria can include hoarseness, a "barking" cough, and a fever. The membrane can also obstruct the airway. This type can also lead to death due to these complications.
Cutaneous: More common in the tropics or among the homeless population in the United States. This type causes a rash or clearly outlined ulcers with a membrane. But the skin type of diphtheria is less dangerous since most infections do not cause the toxin to be released which results in fewer symptoms and complications. Even if the bacterium involved does produce the toxin, the cutaneous type is less severe.
Symptoms usually appear 2-5 days after exposure but the range can be from 1 to 10 days in different cases.
Most of the most serious complications of diphtheria, beyond the airway obstruction from the membrane, are the results of the toxin. They include:
Inflammation of the heart (myocarditis): Can include heart arrhythmia; if it happens early in the course of the disease it is often fatal.
Inflammation of the nerves (neuritis): Between the third and fifth week of the disease, paralysis of the soft palate (back of the throat), eye muscles, limbs and diaphram can occur. If the diaphram is affected it can cause pneumonia, breathing problems or even death.
Inflammation of the kidneys (nephritis): Can result in kidney damage.
Infection of the middle ear can also be a complication.
If you are interested in looking at some of the symptoms in living color, this website, http://www.vaccineinformation.org/diphther/photos.asp, has a number of graphic images of the membrane in the throat and other manifestations of diphtheria. Not for the weak of stomach, but as true hypochondriacs I'm sure you may want to take a look and make sure you don't have any of these symptoms.
Of course, the most severe "complication" is death. Even today, the overall death rate for this disease is 5-10%, and up to 20% among young children under 5 or people over 40.
How is it diagnosed?
Initial presentation of symptoms indicative of diphtheria are enough to motivate a physician to start treatment even before the definitive diagnosis, given the time-sensitive nature of catching the disease before too much toxin is produced.
A throat culture is also taken to identify the presence of Corynebacterium diphtheriae , the diphtheria bacterium. Sometimes more complex tests are needed to definitively diagnose the disease, including staining of the material in the membrane of the throat or testing of antibodies in the blood.
How is treated?
If initial examination indicates diphtheria, treatment should be started immediately, even before test results are available.
Diphtheria anti-toxin is given as a shot into a muscle or through an IV (intravenous line). The anti-toxin is strictly controlled by the Centers for Disease Control. It is produced in horses and dates back to its development in the late 1800's. People can be allergic to it, so a patient should be tested for sensitivity before using the anti-toxin. Anti-toxin does not neutralize the toxin if it is already in the body's tissues, but it will bind with circulating toxin and will prevent further progression of the disease.
The infection is then treated with antibiotics, such as penicillin or erythromycin. They may be administrated orally or by injection. After 48 hours the disease will no longer be contagious.
People with diphtheria may need to stay in the hospital while the anti-toxin is being received, and should be isolated until no longer contagious.
Depending on symptoms, other treatment may include:
-Fluids by IV
-Insertion of a breathing tube
-Correction of airway blockages
Anyone who has come into contact with the infected person should be receive immunization or booster shots against diphtheria. Protective immunity lasts only 10 years from the time of vaccination, so it is important for adults to get a booster of tetanus-diphtheria (Td) vaccine every 10 years.
Those without symptoms but who carry diphtheria should be treated with antibiotics.
Of course, the best thing to do is not to get diphtheria in the first place. In the developed world, most people are vaccinated as children. The diphtheria vaccine is usually given in a combination shot with tetanus and pertussis vaccines, known as DTP vaccine. A child should have received four DTP shots by 18 months of age, with a booster shot at age 4 years to 6 years. After that, diphtheria and tetanus boosters should be given every 10 years to provide continued protection. The diphtheria toxoid (inactivated toxin that causes the body to produce protective antibodies) vaccine was developed in the 1920's but was not widely used until the 1930's and 40's when it was combined with the pertussis (whooping cough) and tetanus vaccines and began to be used routinely.
Will you get it?
If you live in the United States or western Europe, it isn't likely at all. From 1980 to 2004, only 57 cases of diphtheria have been reported in the United States; only 5 since 2000. Most occurred in adults, with over 40% of them in adults over 40, in people who were unimmunized or had let their immunity lapse.
This chart shows the dramatic decrease in diphtheria deaths after the vaccine became widely used.
However, other parts of the world still have a problem with diphtheria due to undervaccination and poor living conditions. As mentioned previously, the newly independent countries that were formerly part of the Soviet Union had a severe outbreak in the 1990's. If you are traveling to other parts of the world, make sure your vaccinations are up to date.
Information on this topic was taken from the following sources:
Saturday, March 10, 2007
This entry is actually by request...a friend of mine has two daughters who have struggled with eating disorders. Since one of her daughters is still bulimic, my friend is still looking for answers as to how to best deal with this difficult affliction.
I have had past experience with someone with an eating disorder as well. My roommate in college freshman year became anorexic soon after we started living together. Her parents were divorced, she lived with her mother and stepfather; she did have a good relationship with her biological father but he lived far away, in California, as he was in the film industry. Her mother had gone to private school in New York City when she was growing up and had been quite the social butterfly. But her daughter, my roommate (we'll call her Cindy), was not the same type. She was serious and studious; her forte was to study hard and get good grades. A little bit on the chunky side, she was not beautiful but not homely either. But no matter how good her grades were, her mother always asked about her social life, which was nonexistent.
When we first met, we got along fine, as I too was not a social phenomenon. I was glad to have been paired with someone on my own level socially. So we went to a couple of mixers together, had some good times, and studied in our rooms together. But shortly after the beginning of the school year, Cindy decided to go on a diet and really change her life. She was still trying to live up to what her mother wanted her to accomplish - being popular.
Cindy started out dieting in a fairly normal way: eating salads, tuna, fruit, etc. But gradually it became more and more pathological. Eventually she was eating nothing but iceberg lettuce. No tuna. No chicken. No fruit. After awhile she had lost enough weight that she could put on her old jeans and button them and pull them down without unbuttoning them.
She lost all interest in anything; she didn't have the energy to go out and go to mixers anymore. She would come back from class, do her homework, and lie on her bed staring at the ceiling. It didn't help that the college we attended was all women and the only way to meet anyone of the opposite sex was to actually make an effort; there were no men in our classes. So her social life did not flourish despite her weight loss, and she continued to want to lose more.
Luckily for Cindy, after freshman year when she went home, her family must have realized there was a problem. She did not return to school in the fall; instead she transferred to the University of South Florida, where her beloved older brother was already a student. The last I heard of her, she had done well there, apparently was eating in a healthier way, and by senior year was engaged to be married.
Not all people with eating disorders have such happy endings. There were two other girls I was acquainted with in college who were seriously anorexic, to the point of needing hospitalization to prevent them from starving themselves to death. Cindy, although she qualified for the definition of anorexia, never got to that point.
Many people know someone who they suspect suffers from some kind of eating disorder; you may have someone in your family who has one. Others may have told you that you have one. This article will help you understand what constitutes an eating disorder, what types there are, why people develop them, and what can be done to help those who suffer from this illness.
Eating Disorders: What are they?
Eating disorders are serious, but treatable, medical illnesses. People suffering from eating disorders typically become obsessed with food and their body weight. Eating disorders afflict several million people at any given time, most often girls/women between the ages of 12 and 35. In fact, over 90% occur in an even narrower age range of girls/women 12-25, according to the National Alliance of the Mentally Ill. However, these disorders can occur in boys and men as well, and in people of any age. Eating disorders are often associated with other forms of psychiatric illness such as depression, obsessive-compulsive disorder, bi-polar disorder, and others.
These illnesses come in three main types:
Anorexia Nervosa, which is the type of disorder Cindy had: Self starvation and excessive weight loss. The person with anorexia can be rail-thin and still think they are fat.
Another form of disorder is Bulimia, also called Bulimia Nervosa, where the person binges on food and then forces themselves to vomit. Sometimes they use laxatives to purge as well. Often these people have a normal appearance in terms of body weight. The word "bulimia" comes from a Greek word meaning "extreme hunger."
There are also Binge Eaters, who are compulsive overeaters, who eat beyond the point of feeling comfortably full. While there is no purging, there may be fasts or repetitive diets and often feelings of shame or self-hatred after a binge.
There are other combinations of eating disorders, with aspects of more than one. Someone who is anorexic can become bulimic and vice-versa. All eating disorders involve an unhealthy relationship with food and try to use food and weight as a way to deal with emotional problems and issues of control.
What are the symptoms?
- Deliberate self-starvation with weight loss to 15% or more below normal body weight
- Fear of gaining weight
- Refusal to eat
- Denial of hunger
- Constant exercising
- Sensitivity to cold temperatures
- Absent or irregular periods
- Loss of scalp hair, eyebrows
- A self-perception of being fat when the person is really too thin
- Anxious or ritualistic behavior at mealtimes
- Irregular heart rate
- Baby-fine hair covering the body (a condition known as lanugo)
- Mild anemia
- Brittle nails and hair
- Low blood pressure
Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa are often of normal weight, although some can be slightly underweight, others overweight or even obese. But they are never as underweight as anorexia nervosa sufferers. Those with bulimia nervosa binge eat frequently, often consuming thousands of calories by eating foods that are high in carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.
After a binge, feelings of loss of control, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative or diuretic (which removes water from their system). This cycle is usually repeated at least several times a week or, in serious cases, several times a day.
The signs and symptoms of bulimia include:
- Recurrent episodes of binge eating
- Feeling a lack of control over eating behavior
- Eating much more food in a binge episode than in a normal meal or snack
- Following a binge with efforts to prevent weight gain — such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise
- Unhealthy focus on body shape and weight
- Damaged teeth and gums from gastric acid contained in vomit
- Swollen cheeks from regular vomiting
- Irregular heartbeat
Binge eaters lack control over their eating habits, and binge at least twice a week for at least six months in order to be diagnosed as a binge eater. Binge eating is one form of eating disorder that males and females are equally likely to develop, according to the Mayo Clinic.
The signs and symptoms of binge-eating disorder include:
- Recurrent episodes of compulsive overeating not followed by purging
- No control over eating behavior
- Feelings of shame or guilt
- Joint pain
- Gallbladder disease
- Increased blood pressure and cholesterol levels
Many kids and teens who develop eating disorders often manage to hide them from their parents. Warning signs to watch out for are if the child avoids eating with the family, excessive preoccupation with weight and body appearance, wearing baggy clothes, and long visits to the bathroom shortly after eating.
What causes eating disorders?
There are a number of theories about the cause of eating disorders. There may be a genetic component. Research has shown that in some cases the areas of the brain governing appetite and digestion aren't functioning properly. Family behavior, culture and the effect of the media's preoccupation with thin celebrities and models have all been identified as possible causes. Certainly our culture's focus on the importance of being thin has resulted in many young girls growing up with a distorted view of what is normal and desirable in society.
Risk factors for developing an eating disorder include:
- Gender (more women than men)
- Age (younger, as mentioned above)
- Family influence (feelings of insecurity within the family, stemming from overcritical parents or siblings, or teasing about appearance)
- Heredity (more common if another family member also has had an eating disorder)
- Other emotional disorders (depression, obsessive-compulsive disorder, etc.)
- Participation in highly competitive athletic activities
Beyond genetic and cultural co-factors, there tends to be a pattern in the families of those suffering from eating disorders. Eating disorders can be related to problems during upbringing, resulting in low self-esteem; there may be over controlling parents (particularly mothers and distant fathers), and sometimes sexual abuse. Those with eating disorders often fear sexual maturation, have trouble coping with stress, and tend to behave in a non-assertive manner. They try to avoid conflict and seldom resolve conflicts with others in a mature way.
These families are often over protective, and there may be alliances of the anorexic daughter with one parent or another (called triangulation). The family overall tends to have difficulty coping with stress; the parents may have an unacknowledged problem in their relationship, and enlist the daughter to balance an otherwise unhealthy situation. Parents are often affectionate and intrusive, but may be neglectful and controlling.
Anorexics usually are perfectionists. They set very high standards for themselves and feel they always have to prove their competence. A person with anorexia may also feel the only control they have in their lives is in the area of food and weight. If they can't control what is happening around them, they can control their weight.
Sometimes focusing on calories and losing weight is their way of blocking out feelings and emotions. Because of their low self-esteem they sometimes feel they don't deserve to eat. The anorexics usually deny that anything is wrong.
Bulimics also do not feel secure about their own self worth. They usually strive for the approval of others and hide their own feelings. Food becomes their source of comfort. Bulimia also serves as a function for blocking or letting out feelings. they tend to be impulsive rather than perfectionists. Unlike anorexics, bulimics do realize they have a problem and are more likely to seek help.
Binge eaters use food as a way to cope with or block out feelings and emotions they do not want to feel. IThey may use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves or fill a void.
People with anorexia have a greater variety of health complications and a greater risk of death (either from weight loss complications or suicide) than do people with bulimia. However, both eating disorders can result in serious health problems.
Anorexia can cause heart problems, particularly due to irregular heart rhythms and reduced size of the heart muscles. (Karen Carpenter, the singer, died of heart problems related to her history of anorexia.) In addition, changes in reproductive hormones and in thyroid hormones can cause absence of menstruation, infertility, bone loss and retarded growth. Disruption of the body's levels of fluids and minerals can create an electrolyte imbalance. Unless restored, this imbalance can be life-threatening. Anorexia may cause brain and nerve damage, seizures and loss of feeling.
Bulimia does not cause as severe health problems as anorexia, since bulimics tend to maintain a more normal weight. Complications may include: Teeth and gum problems, low potassium levels (which can lead to weakness and heart arrhythmias), irritation of the walls of the esophagus and rectum.
Binge eaters may develop high blood pressure, high cholesterol, heart disease, gallbladder disease or type 2 diabetes.
How are eating disorders diagnosed?
Often a family will bring in the afflicted family member to the doctor when they realize there is a problem. Or, the person may realize themselves that they have a problem and go to the doctor.
In addition to finding out whether the person qualifies as being the victim of an eating disorder based on their eating behaviors and symptoms, the physician will also perform a complete physical examination to ascertain whether the person is experiencing any of the side effects of the particular eating disorder. He or she will record the patient's weight and then run a number of tests. These tests should include:
- Complete blood count (to check for anemia and other health problems)
- Blood chemistry (to check for performance of various organs)
- Electrocardiogram (to identify heart damage or irregular rhythms)
- Chest X-Ray (to see whether the heart size has changed)
- CT scan of brain, digestive tract
- Bone density test
If any of the tests show effects from the eating disorder, these problems need to be addressed along with the underlying cause, which is the eating disorder itself.
How are eating disorders treated?
For severe anorexia nervosa, hospitalization is sometimes required to rehydrate the body, balance the electrolytes and begin bringing nutrition back into the body.
If the situation is not as dire, the patient can be treated at home, and a nutritional program prescribed to lead to a gradual weight gain.
For all types of eating disorders, a combination of various therapies is needed, including nutritional education, psychotherapy and family counseling. Medications may be prescribed to reduce vomiting, anxiety and associated depression.
Psychological counseling must address both the eating disordered symptoms and the underlying psychological, interpersonal, and cultural forces that contribute to, or maintain, the eating disorder. The person needs to change their relationship with food.
Some feel that cognitive behavioral therapy is particularly helpful in eating disorders. Cognitive-behavior therapy directly targets the binge cycle. The therapist and patient work together to change eating behaviors, to stop purging, and re-establish natural and healthy eating patterns. Adoption of more flexible eating patterns and learning coping skills are central to preventing binges. Education about meal-planning, nutrition and the ineffectiveness of purging techniques are often a part of treatment. Treatment also targets thoughts and feelings that can trigger binge-eating, including perfectionism and “all-or-nothing” thinking.
Nutritional counseling is also necessary and should incorporate education about nutritional needs and planning for and monitoring rational choices of the individual patient.
Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy and medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications under careful medical supervision have also proven helpful for some individuals.
These disorders often respond to antidepressant medications in conjunction with therapy. Doctors often prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine. Other antidepressant medications may include venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). These drugs also help with anxiety.
Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. Other therapies that may be tried include dialectical behavior therapy, which helps people regulate their emotions; drug therapy with the anti-seizure medication topiramate; weight loss surgery; exercise used alone or in combination with cognitive-behavioral therapy; and self-help.
The Bulimia Nervosa Resource Guide has a wealth of information on Bulimia specifically. http://www.bulimiaguide.org/index/category.aspx?lid=465
Will you get an eating disorder?
It depends. If you have some of the risk factors, and are still young, you could become one of the 10 million girls or women, or the million or so boys/men in the U.S. who suffer from an eating disorder such as anorexia or bulimia. However, if you've reached a relatively mature age without any significant issues with food, you will probably not develop one of these illnesses later on.
Perhaps the more important question would be, do you HAVE an eating disorder? Think about your own eating habits and behaviors. Anorexics are often in denial that they have a problem. Be sure that you aren't one of them.
One thing is certain, when there is a person with an eating disorder within a family, it is not just about that person. It is about the family. Not only can family dynamics be a co-factor in the development of the disorder, but once a family member has the disorder, their affliction affects everyone else in the family as well. So it can perpetuate or worsen the family dynamics, and in order to address these issues, the family must all be involved.
For more information please see the links below - there are a myriad of information sources about this subject and this article has only skimmed the surface.
Information taken from the following sites:
Sunday, March 4, 2007
My father had major depression at least three times in his lifetime; once in college, back when they just called it a "nervous breakdown;" and two specific times after he retired, with long periods of continuous low spirits in between crises.
His mother also was prone to depression, and was hospitalized in the 40's and given electroshock therapy. And we found out well after he died that my father's father had also suffered from depression and had committed suicide.
Luckily for me and my half-sister, we seem to have dodged the family tendency; perhaps the genes on our respective mothers' sides were dilutive. Neither of us has had a major depression although we do have our periods of the blues from time to time. However, one of her daughters is bi-polar.
Why am I writing about depression here? Is it a condition that hypochondriacs tend to fear? No, but hypochondria can be related to depression. Two-thirds of hypochondriacs also have another psychiatric illness such as depression or obsessive-compulsive disorder. http://www.medicalnewstoday.com/medicalnews.php?newsid=9983
Some people, like my father, battle depression off and on for their entire lives; others have a mild and transient bout of it during a stressful period of their lives or during menopause.
On a personal basis, I have had a tendency to worry about things all my life, particularly when it came to my health, despite the fact that I was really relatively healthy. The older I got the more obsessed I became with my health and it got to the point that I could just read about a symptom that I had and if there was a possibility of it being something fatal, I'd actually get a panic attack thinking about it.
Then two years ago I actually got something wrong with me - oral cancer, of the tongue - and the hypochondria "paid off." I had gotten so neurotic over this tiny little sore on my tongue and was so sure it was cancer that I ran to the oral surgeon within a couple of weeks and had it taken off. As it turned out, it actually was cancer, but so early that it was not likely to have spread and I didn't need further treatment after additional surgery was performed to make sure the biopsy had taken it all off. (I'll write a future article on oral cancer). In a way, it was lucky I worried so much about things or I might have waited too long to do something about it.
After this incident, however, I was even more paranoid about my health and was feeling down all the time. Two of my friends had been on Prozac, one during menopause on a temporary basis, and another on an ongoing basis. I knew none of us was in the throes of a major depression as my father had been; my friends were able to work and function, they were just down, as I was. And I finally decided to ask my doctor about going on Prozac since it worked for my friends. She was willing to prescribe it for me and I started taking it and it was the best decision I ever made.
I feel as if I have a new lease on life. It's not as if I couldn't enjoy myself before, but everything was so extreme. All I'd have to do is hear a song on the radio that was sentimental or sad or reminded me of something, and the next thing I'd know I'd be crying all the way to work and have to fix my makeup before I went in! I couldn't even go to a folk music concert without bawling over some song. I had to take kleenex with me everywhere!
Now, although I can still get sad over something worthy of sadness, I am in control of my emotions and feel much more able to cope with whatever comes along. And, I've stopped being obsessed over my health. It's a very subtle effect; I still feel totally normal and like myself, and I actually feel as if I've just changed my attitude about things. But I'd be willing to bet if I went off the drug my new attitude would change and go back to the way it was.
My father was always a proponent of "better living through chemistry" - he was taking Miltown and Librium in the 60's and 70's, and went on antidrepressants in the 80's when he had his depressive crises. I never thought about whether I needed to be on any drugs until it finally dawned on me that you don't have to be catatonically depressed to need a little help. So now I take the lowest dose of Prozac (10 mg.) and an occasional Xanax for anxiety (also the lowest dose) and I am a lot happier with my life. It may not be for everyone, but if you feel you may need some help, don't deny yourself. It is nothing to be ashamed of.
And, if you are in a much worse place, and are deeply depressed, it can be a life-threatening illness. Please don't hesitate to consult your family physician and ask for a recommendation for a psychiatrist who can prescribe medicine. A combination of therapy and medicine is usually the best solution for a severe depression.
So, without further preamble, following are the details about depression.
What is depression?
Depression is an illness that causes a person to lose interest in life, can affect their eating and sleeping habits, and affects both the mind and the body.
There are various types and levels of depression, as follows:
Major Depression: This is what my father had during his worst periods. It is disabling. A person with major depression finds it impossible to function; they can't concentrate on work or on pleasurable activities; they often just sit and stare into space. They often feel so hopeless that they think life is not worth living and can see no way out besides ending it all. This is a life-threatening type of depression and sometimes can require hospitalization (my father was hospitalized several times). This is not a mood that a person can pull themselves out of by taking up a hobby or volunteering at a soup kitchen. When a person is affected by depression, he or she cannot remember ever feeling good and therefore can't imagine they will ever feel good again.
Dysthymia: This is probably what I have a tendency to have. Unlike major depression, dysthymia involves long-term, chronic symptoms that do not disable a person but prevent them from ever feeling really good or truly happy. Some people who suffer from this syndrome also have major depression at some time in their lives.
Bi-polar Disorder: People with bi-polar disorder have also been known as "manic-depressive." This disorder is a type of depression wherein the patient has cyclic episodes; at some periods they will experience "mania" (where they are extremely energized and excited, can go without sleep, and feel invincible), while during other periods they may have all the symptoms of a major depression. Manic episodes can lead to a psychotic break where the patient loses touch with reality. This has happened to my half-sister's daughter, my niece, who suffers from bi-polar disorder. Thankfully, she has found medications that are stabilizing her.
My father had a manic period later on in his life; looking back, I often wonder whether his moodiness during the time I was growing up were mild symptoms of bi-polar disorder.
What are the symptoms?
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness and pessimism
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed (including sex)
- Decreased energy, fatigue; feeling "slowed down."
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Loss of appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking (often skipping from one thought to another)
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Some people who are depressed have thoughts of hurting themselves, or actually do hurt themselves, to try to take away the pain of the depression by distracting themselves from it with physican pain. It can also be to punish oneself, or to divert anger. In fact, depression is sometimes decribed as "anger turned inward."
Recently there has been media attention on teens who cut themselves, which may be a manifestation of depression or obsessive-compulsive disorder. More information can be found here:
What causes depression?
Major depression is caused by a chemical imbalance in the brain or changes in brain structure. However, there may be a number of reasons why the brain chemicals get out of balance.
Some types of depression may be inherited; there is a particular tendency for bi-polar disorder to run in families, and a genetic component has been identified. However, not everyone with the genes that predispose them to get bi-polar disorder actually develop it, so other co-factors may be involved, such as stress or illness.
Certain illnesses such as Parkinson's Disease, Alzheimer's Disease, strokes, heart attacks, cancers, and more - can be factors in developing depression. In fact, anyone who exhibits signs of depression without having any previous tendencies to the illness should be carefully checked for other illnesses that may be the actual cause.
People who are overwhelmed by stress, have low self-esteem or have pessimistic viewpoints tend to develop major depression. However, it is hard to know whether their issues are symptoms of incipient major depression or the cause of it.
Hormones can play a part in depression. In particular, disorders of the thyroid can be a factor. People who are hyper-thyroid (too much thyroid hormone) may seem manic, with irritability, anxiety, and nervousness; while those with an underative thyroid (hypo-thyroid) may seem depressed, lethargic, and apathetic. It is very important that anyone with manic or depressive symptoms have tests of their thyroid function. Please see this link for more information. http://www.tsh.org/disorders/related/depression.html
Women, with all the hormonal fluctuations they are prone to, are more likely to develop depression than men. Their multiple responsibilities for the household, children and job may contribute to their stress and trigger depression as well.
Men are less apt to be depressed, but when they are they are less likely to admit it, less likely to seek help, and doctors are less likely to identify it. Men are four times more likely to successfully commit suicide than women, although more women attempt it.
Depression can play a role in coronary heart disease, and men who are depressed have a higher death rate from heart disease than women.
People with undiagnosed depression may "self-medicate" with alcohol or drugs to make themselves feel better. This is particularly likely with men. Men may also work obsessively long hours or exhibit their depression as anger and irritability.
Depression is often under-diagnosed in elderly people. It is not normal for the elderly to feel depressed, and if they are, family members or caretakers should make sure the elderly person is checked for diseases, overmedication with prescription drugs, or other factors, and if there is no other cause of their condition, then they should be treated appropriately for depression.
Children can also be clinically depressed, and new research is being done to further understand the best ways to treat them.
How is it diagnosed?
The first step is for the patient to consult his or her family physician and get a full check-up. As mentioned above, there are a number of diseases and conditions that can cause or mimic depression, and certain viral infections or medications can also cause the same symptoms. The physician should rule out these possibilities through examination, interview, and lab tests. In cases where a neurological cause such as Alzheimer's is suspected, a visit to a neurologist would be in order. If a physical cause for the depression is ruled out, a psychological evaluation should be done, preferably by referral to a psychiatrist or psychologist.
How is it treated?
There are two major components of treatment: psychotherapy and medication. If nothing else works, electro-convulsive therapy (ECT, formerly known as electro-shock therapy) or other less common therapies may be tried.
There are various types of psychotherapy, from Freudian analysis to cognitive therapy. Overall it is therapy where the patient and his/her psychiatrist or psychologist work in partnership to talk through the patient's thoughts and issues. Here is a helpful link about psychotherapy: http://helping.apa.org/articles/article.php?id=52
Cognitive-Behavioral Therapy is a particularly useful type of therapy for people with depression. My father found it helpful. Instead of focusing on the past and what made the person depressed, it focuses on specific tools and methods to defeat the depression and change the thought patterns. Here is a link to more information about this useful therapy: http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952
Therapy in conjunction with medication is the best way to treat major depression. There are a myriad of medications out there now, and if one doesn't work, another one, or a combination of several, should.
There are several major classes of antidepressants, which all work somewhat differently.
Older types include the tricyclic antidepressants such as Elavil, or the MAOIs (Monoamine Oxidase Inhibitors) such as Nardil and Parnate. My father was on Parnate for a fairly long while and it worked quite well for him. One of the disadvantages of MAOIs is that there are dietary restrictions for those who take this type of drug, as the drug interacts with foods such as aged cheese, red wine, sausage, and certain other substances to cause a dangerous rise in blood pressure.
The more recently developed drugs include the SSRIs, or Selective Serotonin Re-uptake Inhibitors. Prozac and Celexa are popular brands of this type of drug. Effexor is a drug which is part of another similar class of drug called Selective Serotonin-Norepinephrine Reuptake Inhibitors. All of these medications work to modulate Serotonin and other brain chemicals which control mood.
Lithium has been used for many years for bi-polar disorder and is also useful for other types of mood disorder. Not everyone can take it as it has to be carefully monitored and can cause complications if the patient has thyroid or other specific problems. Other drugs that are useful either alone or in combination with lithium include anti-convulsives such as Depakote or Neurontin. Many people with bi-polar disorder also take anti-anxiety medications.
For more information about all the different types of drugs used for depression and related disorders, please see this link. http://web4health.info/en/answers/depr-treat-links.htm
Almost all medications for depression take some time to be effective, often several weeks, so the person must be patient and wait for the results. In addition, some medications may be harmful if stopped abruptly, so the patient should never go off medication without telling the doctor. Often patients feel better after taking the medication and decide they don't need it anymore. This is dangerous, as often after medication is stopped, the person can sink back into depression. Just as they can't ever imagine feeling better while they're depressed, depressed people often forget how bad they once felt once the medication has taken effect. My father made this mistake after he'd been on Parnate and went off it once he was feeling well, and his depression returned.
All of these medications can have side effects, including dry mouth, insomnia, drowsiness, dizziness and headaches. If you are taking drugs that give you undesirable effects, be sure to tell your doctor so he or she can modify the dosage or change medications until something is found that is tolerable. Overdoses can be dangerous so always take the medication as it is prescribed.
Some people have tried herbal remedies such as St. John's Wort for depression. It seems to work for mild depression, and has been used extensively in Germany for treatment of depression. My husband became depressed after being in New York on 9/11/2001 and has found St. John's Wort to be helpful and continues to take it on a regular basis. It is very important NOT to take St. John's Wort if you are already taking some other type of prescription medication for depression, as they both work similarly and can cause a dangerous interaction. In addition, St. John's Wort can interfere with other medications for other illnesses so always tell your doctor if you are taking an herbal remedy.
As mentioned, for people with intractable depression, or for those who are unable to take medications, there is electro-convulsive therapy, or ECT. This is no longer the scary thing it was back in the mid-20th century. ECT is the next generation of this type of treatment and is much safer and less traumatic for the patient than in the past. A muscle relaxant is given before treatment. The patient is anesthetized for the process and just a small shock is administered to the brain in a more focused way than in the old days, using electrodes at specific locations on the head, which cause a short seizure. The patient wakes up and doesn't remember the experience. Treatments are usually given three times a week for a period of time in order to be effective. Some transient memory loss can occur but usually patients get their memories back. My father was treated with ECT several times when nothing else would work and it successfully pulled him back from his blackest hours. For more information, please see this link: http://familydoctor.org/058.xml
Will you get it?
Possibly. In any given 1-year period, 9.5 percent of the population, or about 20.9 million American adults, suffer from a depressive illness.
If you think you or someone you know is depressed, please do not hesitate. Go for help. No one should have to suffer from depression, with all of the remedies available today. And no one should be embarrassed or ashamed to admit they are depressed. It's no different than being a diabetic - there is a chemical imbalance and it must be treated.
Much of the above information was taken from the National Institutes of Mental Health website, http://www.nimh.nih.gov/publicat/depression.cfm#intro. Additional useful information can be found on Medline Plus: http://www.nlm.nih.gov/medlineplus/depression.html#fromthenationalinstitutesofhealth