Depression: A Misunderstood Disease by Stephanie Mallet - HTML preview

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They develop irregular sleeping patterns by staying awake for long

hours at night and then are unable to wake up in the morning for

school. They sleep to excess during daylight.

All these irregular habits may trigger headaches, stomach aches and

immense fatigue.

Intense Feelings: Children develop very intense feelings which

grow into anger. Then they:

have arguments with siblings,

cry uncontrollably,

complain about everything and everybody,

accuse parents for all bad happenings,

take foolish risks, and

develop a careless attitude for anything that could happen to them.

It is best to seek professional medical help if more than two or three

of these symptoms persist for a long period. Medications and

psychotherapy can help to control unipolar depression in children.

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9. Unipolar Depression in Adolescents

Adolescents often fall prey to unipolar depression. The incidence is

particularly high in post-pubertal teenagers.

Teenage girls may exhibit a higher incidence of depression than

teenage boys do.

Unipolar depression could be due to:

• child abuse,

• loss of a parent or close relative,

• separation of parents due to divorce,

• chronic illness,

• poor social skills or

• insufficient care given by their parents.

But, it is difficult to identify depression as it may resemble normal

adolescent behavior in teenagers.

Teenagers with unipolar depression exhibit symptoms such as:

withdrawal from regular activities,

difficulties in school,

relationship problems with friends,

irregularities in eating and sleeping patterns,

excessive indulgence in abuse substances including tobacco and

alcohol, low moods, becoming irritable, having very low self-esteem,

and suicide attempts.

Teenagers exhibit more cognitive symptoms than normal physical

symptoms associated with unipolar depression. Feelings of despair,

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hopelessness, and low self-confidence are prominent symptoms of

unipolar depression in teenagers.

Teenagers may develop hypersomnia or excessive sleeping in place

of the normal insomnia associated with unipolar depression in


The average duration of a unipolar depression episode could be nine

to twelve months. This could rob teenagers of a crucial year of

academic progress and learning of work skills.

If the depression goes unnoticed, it could have long-term

consequences on their psychological and vocational development.

Unipolar depression could be a more common occurrence in

teenagers with a family history of depression.

Teenagers that have many risk factors and come from poor social

backgrounds could be more likely to suffer from depression.

Detection of Warning Symptoms

Although most symptoms of unipolar depression are similar to

adolescent behaviors, if the symptoms continue for more than a

month, it may be best to visit a trained professional for testing.

School counselors and similar caregivers could have a great

soothing effect on depressed teenagers. Often, teenagers confide

their problems in their friends.

Cognitive behavioral therapy is the best treatment option for

teenagers with unipolar depression. This treatment method does not

use any medications.

Instead, trained counselors teach teenagers to combat all negative

thoughts and help them to come out of their depressed moods.

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10. Unipolar Depression in Women

Women are twice as likely as men to experience unipolar

depression. One in every five women may develop unipolar

depression at some time in their life.

This may cause:

• extreme sadness,

• irritability,

• fatigue,

• anxiety, and

• drastic changes in eating and sleeping patterns.

Depressed women may also experience chronic pain and feel

worthless and hopeless.

It may also increase suicidal tendencies.

The incidence of unipolar depression is higher in women than men

due to biological differences of their hormones and genes.

Other causes may include:

• higher stress levels due to work and familial responsibilities,

• increased rate of sexual abuse,

• being a single parent,

• caring for aged parents, and

• social factors like poverty.

Normally, women experience depression during or before menstrual

periods, after pregnancy and during menopause. However, such

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depression episodes normally do not last long and should subside

within a week.

Women with a history of unipolar depression could experience

longer bouts of depression during such periods and may require

medical care and attention.

Elderly women encounter unipolar depression due to:

• death of their spouse,

• serious illnesses like diabetes, cancer, arthritis and heart


Although unipolar depression is not an ailment of old age, chances

of developing it increases in later years due to reduced physical and

mental strength.

Unipolar depression is less reported among African American women

than Hispanic and Caucasian women.

Women that suffered child abuse, sexual abuse or rape in their

growing years are more prone to unipolar depression. Similarly,

women facing harassment at work develop low self-confidence

levels and a feeling of helplessness which may encourage the

development of clinical depression.

Poverty is an important factor for causing unipolar depression in

women. Seventy-five percent of the total US population is women

and children with a low economic status. Depression due to low

morale, sadness, frequent occurrence of negative events,

uncertainty, and limited access to help is common.

Despite all factors and causes for unipolar depression, it does not

signify any special weakness of women.

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You should not leave it untreated or just regard it as a normal part

of being a woman.

Unipolar depression in any form and at any age is probably curable.

The most common treatment option includes a combination of

antidepressants with psychological therapy.

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11. Unipolar Depression in Men

Some research seems to indicate the possibility that men

experience a lower incidence of unipolar depression than women do.

Unipolar depression manifesting in men could occur at any age.

In young boys, it shows when they lose interest in regular playtime

and seek to distance themselves from their friends. Small boys who

prefer solitude and develop irregular eating and sleeping habits may

have depression.

Unipolar depression in adolescent boys could make them more

aggressive, causing them to take drastic steps for small upsets.

They become very angry at the slightest pretext and are always

ready to fight.

Further, fighting among siblings and teenaged boys could become

ugly. Adolescent boys with unipolar depression exhibit a low-level of

self-confidence and start dropping their academic grades.

Normally, men in their middle age are the supporters and

breadwinners of their family. Unsuccessful careers, broken

relationships and an inability to perform and deliver could make

them a social recluse.

Such men are unable to maintain their confidence levels and feel

lacking in all aspects of their life.

Any emotional upsets from their younger days may surface now.

This makes them more susceptible to physical and mental illness.

Anxiety can take the form of reduced mental health and may even

lead to symptoms of schizophrenia.

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Substance abuse, like drugs and alcohol, can take a toll on any

healthy male. Men often take refuge in these to overcome their

failures in marriage or professionally.

The result may be unipolar depression.

Men in their sixties could experience unipolar depression due to loss

of a spouse, poor physical health, ailing mental health or the

presence of various diseases like Alzheimer’s, Parkinson’s or

respiratory and heart ailments.

Most men at this stage feel they have nothing to do and therefore

become susceptible to loneliness and boredom. This may cause

unipolar depression.

Medical care and treatment is essential for fixing unipolar

depression in men of any age group. Sensitized family members and

friends can boost their morale further and help to prevent more

serious outcomes.

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12. Unipolar Depression in the Elderly

Unipolar depression is common in the elderly. Physical and mental

problems often surface in old age.

The elderly often face various disorders like emotional upsets,

loneliness, boredom, poor physical health and increased

susceptibility to different ailments.

Depression may manifest itself in some form. This is why unipolar

depression often goes unnoticed in the elderly until it is well


Dementia and schizophrenia cause marked changes in behavior of

the elderly. This can have serious effects and make the elderly more

dependent on different medications.

Some medications, like some antibiotics and steroids, may cause

depression as a side effect.

Such depression could take the form of unipolar depression in the


Often, unipolar depression symptoms are treated as common

symptoms of old age. Therefore, diagnosis and treatment is later

and at a reduced level.

Another major impediment to prompt treatment for unipolar

depression is that the elderly do not commonly report such

symptoms until it becomes advanced.

Another major cause is the social stigma attached to unipolar

depression. The elderly feel that admitting to their depression

symptoms could make them a social outcast and, therefore, many

prefer to hide all symptoms until they become very obvious.

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This is one of the most important causes for increasing suicides

among the elderly.

Insomnia and sleep disturbances are common symptoms of various

ailments affecting the elderly. So, these symptoms do not stand out

among the different symptoms of unipolar depression in the elderly.

However, regular sleep problems should not be ignored and

remedial measures are necessary to counter unipolar depression in

the elderly in the initial stages, whenever possible.

However, unipolar depression in the elderly is not anything to be

worried or anxious about. There are medications and psychotherapy

treatments available that can be modified to suit the elderly.

This helps them to get more enjoyment from all the pleasures of life

with less restriction.

It also improves their general health and their ability to care for


Various treatments are claimed to have success rates ranging from

60% to 80%. But, treatments for unipolar depression take a longer

time to deliver the desired results in the elderly.

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Part-IV: Diagnosis and Clinical Aspects

13. When to Seek Medical Advice

Unipolar depression exhibits many symptoms like:

• changes in eating and sleeping patterns,

• a constant melancholic feeling,

• excessive tiredness,

• lacking desire or energy to do anything,

• disconnecting socially, and

• harboring an overall feeling of hopelessness, worthlessness,

and total inadequacy.

If you have these symptoms for more than two weeks, you should

disclose them to close family members or friends and seek medical


Unipolar depression is nothing to be ashamed or afraid of.

Many trained medical professionals can make the correct diagnosis

and administer any necessary treatment. You may need the help of

a psychotherapist or psychiatrist.

Unipolar depression often responds positively to simple

antidepressants and therapies. It could take around a month for

your medications to take full effect, although you can notice

changes after two weeks.

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14. How Is Unipolar Depression Diagnosed?

Unipolar depression is mostly a psychological ailment and it

requires a thorough psychological evaluation.

But, doctors first diagnose you for any possible medical ailments

that could cause depressing thoughts and deficiencies. Doctors also

check into any medications you are currently taking like those for

high blood pressure, oral contraceptives or others that may have

depression as a side effect.

If you do not have any serious physical ailments or taking any

medications or other treatment that might have caused your

depression, doctors could put you under a psychological evaluation.

This evaluation normally starts with a complete check of any family

history of depression. If there has been any instance of depression

among family members you would have to disclose:

• all treatments,

• medications used,

• how long the depression lasted,

• have there been any relapses, and

• how that patient is now.

Next, a psychologist could evaluate all your symptoms completely.

They need to know;

• the duration of your symptoms,

• how long you have experienced them

• whether they have become worse over time

• do you experience them constantly or in specific bouts

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• does anything in particular heighten your symptoms, and

• how severe are your symptoms?

You need to tell the doctor about your alcohol use, drug use, use of

any sedatives, and anything that you are doing which might be


You must tell them if you harbor any thoughts of committing suicide

and how often such thoughts occur.

These mental evaluations are considered along with any sign of the

presence of other diseases like an eating disorder, anxiety disorder,

attention deficit disorder or hyperactivity disorder.

Next, psychologists would do a detailed analysis of any treatments

that you have undergone earlier for unipolar depression or if you

are presently taking any medications.

Then, they would evaluate your present mental status. This will help

them analyze your mental abilities, detect any shortcomings, and

assess if any shortcomings are the result of medication or if they

are independent.

Doctors check whether the occurrence of your symptoms is daily

and for the major part of the day before they consider a diagnosis of

unipolar depression to be likely.


The complete evaluation by your psychologist would determine the

recommended treatment option for curing your unipolar depression.

Normally, psychotherapy sessions prove to be the most effective.

However, sometimes psychologists do recommend antidepressants

for quicker relief from unipolar depression symptoms.

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Doctors could prescribe electroconclusive therapy and

hospitalization in severe cases.

Medications cannot cure your depression problems, but may provide

some relief from physical problems.

So, psychology therapy sessions may deliver desired results. But, it

could take quite some time and you need to be patient and persist

in your treatment procedures.

Friends and family could prove to be a major source of support

during such times.

Chances of recurrence of unipolar depression after successful

treatment could be as high as 50%.

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15. Examinations and Tests to

Determine Unipolar Depression

Doctors normally conduct a thorough physical examination to

detect any underlying problems or ailments in you that could be the

cause for unipolar depression.

There are no laboratory tests or x-rays to determine the presence of

unipolar depression.

If there is no physical ailment, your family doctor could refer you to

a reputable psychologist or psychiatrist.

Psychiatrists and psychologists examine your family history for any

depression symptoms. They will discuss your regular habits,

including any drugs and alcohol.

They will ask you questions on your feelings about life and if you are

thinking deeply about death or similar events with serious


Specialists give children specific assessments to determine their

ability to reason, remember, and think. It could also include a short

verbal test to examine their abilities with speech and thought.

Sometimes, children could undergo blood tests to rule out anemia

or an under active thyroid gland.

Psychologists and psychiatrists use diagnostic tools as specified in

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),

published by the American Psychiatric Association.

The Beck Depression Inventory was created by Dr. Aaron T. Beck in

1961. This is a 21-question survey completed by patients. It

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contains questions related to all possible symptoms of unipolar


There are two health questionnaires, PHQ-2 and PHQ-9. PHQ-2 has

only two questions and your answers to these decide the necessity

for doing PHQ-9.

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16. Self-Testing for Unipolar Depression

Psychological and physical symptoms of unipolar depression differ

from person to person. However, if you exhibit some of the

following symptoms persistently for more than two weeks, it might

be best to seek treatment for unipolar depression:

• Feeling bored, irritable, anxious and agitated

• Losing interest in almost everything in life

• Constantly harboring a feeling of unhappiness and sadness

• Losing your appetite and developing insomnia

• Feeling extremely tired and drained of all energy

• Having negative thoughts about yourself and doubting your


• Losing your self-confidence

• Harboring serious intentions of a suicide

• Feeling that your are worthless and hopeless

• Avoiding people and other forms of social contact

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17. Medical History and Unipolar Depression Diagnosis

Doctors diagnose unipolar depression according to criteria specified

in a handbook called the Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV).

As there are no specific laboratory tests or x-rays to diagnose

unipolar depression, doctors give more credence to your medical

history, family medical history and your symptoms to arrive at the

correct diagnosis.

While analyzing your medical history and that of your family,

doctors consider details relating to:

• Any history of depression among any of your family members

• Any depression episode anytime earlier in your life

• Any thoughts of suicide or death

• Use of alcohol and drugs

Further, they make a complete mental examination to analyze your

neuro-psychiatric abilities like retention power, memory, speech,

thoughts and handling mood changes.

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18. Is It Possible to Avoid Unipolar Depression?

Incidences of unipolar depression have been on the increase in the

last few decades. There are now many more cases of depression in

the developed countries.

Developing countries are also following the trend due to increasing

westernization. The average age of onset of depression has fallen

from the thirties to the twenties.

Although genetics and individual health are the main factors in the

onset of unipolar depression, there are various other factors.

Overcoming these may help to change your susceptibility to

depressive bouts.

Technological dependence is a major contributor to unipolar


Technology helps you get things done faster. You no longer

patiently wait for results. This tends to increase brain activity.

As soon as something does not go your way, you may feel a low and

be less ready to bear the disappointment.

Use of technology should be restricted to important and essential


Unipolar depression takes root when you stop thinking and

analyzing. Allow your brain to work, question and then think about


Study your behavior and your feelings. Such brain activity is healthy

and may help to keep you away from depression.

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Give a lot of importance to your relationships with others.

Relationships cannot be made in a day. Similarly, breaking off too

quickly is also not usually advisable.

Your family, friends, and relatives can be a major source of strength

in your trying times. Respect them and try to make unconditional

love the foundation of any relationship.

This makes you mentally strong and keeps you away from


Depression occurs when you take everything very personally. You

draw wrong conclusions from events that happen and treat them as


You refuse to listen to anybody’s reasoning or look into other

people’s views and analysis of events.

Accusing yourself of all negative happenings is demoralizing. Try to

look beyond the immediate situation and accept events as they

happen rather than questioning every little thing.

Try to flow with the tide and find happiness and satisfaction in every

happening and event. This makes sure you are more impregnable to

unipolar depression.

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19. Life after Unipolar Depression

Unipolar depression makes you feel gloomy, sad, and disinterested

in everything. You feel as if everything around you is boring and

you are unable to get happiness anywhere.

However, proper treatment and therapies can get you out of

unipolar depression. Yes, it will take some time for medications and

therapies to take effect and bring out the desired results.

Antidepressants may have serious side effects and could complicate

matters. Stick to the prescribed dosage and use according to your

doctor’s advice.

Over time, the antidepressants will start taking effect and you can

slowly start enjoying life.

You start experiencing happy feelings just as in the past. But, this

may be temporary. You may enter into a new state of depression

within a short time.

This is probably not a relapse; it sometimes happens due to the way

that antidepressants and therapies work.

After persistent efforts and regular medications and therapies, you

are sure to come out of unipolar depression.

In the initial healing stages, you may feel reluctant to accept that

things are looking up. There could be defiance, as you feel that

depression cannot be cured.

You may be unable to believe that you can be free of depression.

Slowly, you are able to come out of the perpetual gloom. Then, you

will be ready to accept your improved reality and feel that

depression is coming under your control.

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You can enjoy your rebirth and feel happier.

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Part-V: Treating Unipolar Depression

20. Treatment Options for Unipolar Depression

Treatment options for unipolar depression are many.

There is no single proven treatment option that can deliver optimum

results from unipolar depression in all patients. Every treatment

option is for an individual.

Your doctor may use a combination of treatments in accordance

with your emotional and physical condition.

The most common treatment option includes a combination of

psychotherapy sessions and antidepressant medications.

In some severe cases, doctors could advise immediate

hospitalization. This could be to prevent any mishaps if the patient

might prove to be a threat to themselves.

In some cases, it could be a partial hospitalization session where

they sleep at home at night and spend the entire day in a

psychiatric hospital.

Doctors may suggest this treatment option for children and


Unipolar Depression Treatments


In isolation, this therapy is an effective treatment for mild to

moderate forms of depression. Doctors normally recommend it as

the first course of treatment for unipolar depression.

These sessions could be for you alone or with your spouse and other

family members. The sessions help to identify the root cause for

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your depression and addresses it by focusing on essential behavior

patterns and control of emotions.

Psychotherapy sessions consist of talking therapy sessions, behavior

therapy sessions and interpersonal and cognitive behavioral


In talking therapy sessions, psychotherapists talk with you and try

to correct your deficiencies, thinking patterns, and behavioral


In behavioral therapy sessions, psychotherapists teach you new

behavioral forms that could change your depressive state of mind

and help you attain better satisfaction and contentment in life.

In interpersonal and cognitive behavioral sessions, you learn to

overcome your negative thinking and develop a better stance on life

that will help to overcome your unipolar depression.

2. Medications

Common medications for unipolar depression include

antidepressants. There are many antidepressants like selective

serotonin reuptake inhibitors (SSRIs), tricyclics and monoamine

oxidase inhibitors (MAOIs).

These medications stimulate and increase working of natural

neurotransmitters in brain. This induces a positive response and

helps alleviate problems due to depression.

Doctors prescribe such medications for a minimum period of four to

eight weeks. This time is essential for them to cause a marked

improvement in your condition.

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In some cases, doctors would advise continuing use of

antidepressants for six to twelve months, although on a minor

dosage. This could also prevent a relapse.

Antidepressants may cause various side effects like nausea, fever,

diarrhea, headaches etc.

Doctors prescribe an appropriate dosage according to the severity of

your condition.

If you are on MAOIs, you should follow specific dietary and

medication restrictions.

If you are on common medications for any other ailments, MAOIs

could react negatively with such medications.

3. Electroconvulsive Therapy (ECT)

This therapy involves passing of mild electric current to create

seizure-like situation in brain. Doctors prescribe this treatment

option if all other forms of treatment for unipolar depression have

failed to yield any positive results.

Although this treatment is the best option for those with severe

unipolar depression, it could cause serious problems if administered


A complete treatment involves twelve sessions spread over three to

four weeks. Normally, it is three sessions per week.

Each session involves passing of electric current for one to two

seconds while you are on anesthesia. As you are also under the

effects of muscle relaxants, these induced seizures do not affect

other parts of your body.

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This therapy is most suitable for those contemplating serious

consequences like suicide, severe agitation and other irrational


This calms nerves and subdues their over-activity.

This treatment could require hospitalization in some cases.

Alternative Treatments

These treatments include guided imagery, biofeedback, hypnosis,

aromatherapy, yoga, meditation, acupuncture, massage, herbal

remedies and other forms of relaxation.

These alternative treatments aim to relax your nerves by providing


These may prove effective for treating mild depression.

These treatments are easy to practice at home.

Herbal Therapy

Although herbal therapy has been in use extensively in Europe for

unipolar depression treatment, it is also recently being used in the

United States.

However, herbal remedies may cause violent reactions with other

normal drugs and antidepressants.

Always consult your doctor about prescribed dosage of

antidepressant medications and what would be the best treatment

option if you are thinking about starting to take herbal supplements.

Various herbs are claimed to sometimes counter unipolar depression

symptoms effectively.

The most common among them is St. John’s Wort. This herb is

available from a bushy plant that has yellow blooms in summer.

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