The Nature of Depression - Term Paper Example

 Introduction The exact definition of depression has been debated for many years. Some mental health professionals consider depression as a mood disorder (Hales37), while others say that depression is as serious as diabetes and pneumonia, depression affects the body as well as the mind (10). Statistically, everyone will suffer from depression at one time in his or her life. Sometimes it can be harsh, and other times it can be relegated to simple changes in one's life. Depression can also sometimes be a cause for another problem such as flu or hormonial imbalance or a reaction to a tramatic event (17). Ned Gasseuim, a Harvard medical doctor stated that depression is "misery requiring treatment" (19). While the exact definition of depression is debatable most people will agree that it is misery, and that without quick treatment, can be devastating. This essay examines the nature of depression and considers a number of pharmacotherapy treatment options, and as the nursing considerations related to the disorder. Characteristics There are a number of different categories and severities of depression. One of the most common types of depression is bipolar disorder. Bipolar depression causes a person to have swings wildly from frantic highs to humbling depressive lows. New studies have shown that being a substance abuser can cause depression; if someone is using alcohol as a mood regulator or for escape, it’s likely one will have serious depressive symptoms that will only get worse if one does not get help. It has also been proven that random use of marijuana can stimulate depression and mental illness that had not been dormant. Another version of depression is referred to as unipolar depression. Unipolar depression occurs when the person only experiences depressive lows. Both types of depression, however, cause a major depressive episodes characterized by bleak moods, irritablity, sadness, anger, hostility, and a conviction that their misery will never end. Mood disorders are also called affective disorders (37). Some patients also experience mania- intense excitement and mental disorganization that usually requires hospitalization. Even a ‘normal’ depression that everyone goes through is a serious illness, and should be treated. Prevalence & History Depressive symptoms are multifaceted and can be highly prevalent. “They can be insidious, working their way into people’s thoughts, and feelings, diminishing its victims’ emotional and physical well being, along with their personal and family relationships” (Zimbardo et al. 462). Many people are left with an enormous financial burden from lost wages, lost productivity and the high cost of prolonged treatment. The idea that mental disorders are diseases of the mind came into effect in the 18th century. In ancient times, people assumed that everything in the world was associated with the supernatural. People with mental disorders were thought to have been under the possession of demons. In 400 B.C., a Greek physician named Hippocrates took a scientific view of mental disorders. He thought that abnormal behavior was due to a physical cause. What he taught people was that there were four humors: blood, phlem, black bile and yellow bile. If someone had an imbalance of the four humors, abnormal behavior would result. For example, someone with too much black bile would have depression. Someone with an abundance of blood would be warm hearted (Zimbardo et. al 463). Since these ancient discoveries depression has evolved into a major consideration within the medical establishment, and indeed a great amount of scientific research has been devoted to psychiatric medications that function to alleviate depressive symptoms. While St. John’s Wort had been implemented as early as the 19th century for depression, it wasn’t until the mid-1950s that pharmacotherapy became a highly research practice, and until the late 20th century that selective serotonin re-uptake inhibitors (SSRIs) and similar functioning medicinal treatments emerged and became the primary avenue of depressive treatment. Pharmacotherapy People with depression seek help in different ways. Some seek talk therapy while others resort to medication along with this therapy. Antidepressants are a popular way for people to deal with depression. There are many different kinds of antidepressants that are prescribed to people in contemporary psychiatric practice. There are also different theories of how they function. One theory states that selective serotonin re-uptake inhibitors or (SSRI’s) work by specifically inhibiting the re-uptake of serotonin in the brain. As a result, more serotonin is likely to bind receptor sites on brain cells and transmit the serotonin signal. Serotonin is a crucial neurotransmitter. It is the brain’s natural antidepressant and tranquilizer. Therefore, a decrease in serotonin is thought to be a major cause of depression, anxiety and insomnia (Murray 3-4). Another theory states that antidepressants work to re-regulate a person’s receptor-neurotransmitter relationship. Taking antidepressants over a long time period produces complex changes in neuro-receptor sites. “This normalization of neurotransmitter efficacy speeds up a person’s natural recovery process from a depressive episode” (Kastrup et al.). Some popular SSRI’s include Prozac, Effexor, Paxil, and Zoloft. Tricyclic drugs also inhibit the re-uptake of serotonin but they are different than SSRI’s because they are not as selective. Drug selection is based on the patient’s history of response to a certain drug and their drug side effect profile. For example, a trycyclic antidepressant such as nortriptyline may be used because it causes less sedation and lowering of blood pressure than amitriptyline. Some examples of Tricyclic antidepressants include Elavil, Sinequan or Tofranil (Kastrup 4-5). Monoamine oxidase inhibitors, or (MAOI’s) are thought to alleviate depression by increasing monoamines in the brain. Some MAOI’s include Nardil and Parnate. Wellbutrin and Desyrel are classified as miscellaneous antidepressants because they increase levels of both serotonin and nor-epinephrine (Murray 4-5). Most antidepressants take at least two weeks before they start to work. Antidepressants are successful in alleviating depression in as many as 60 to 70 percent of patients (Murray 5). However, there are many side effects patients must be informed of before beginning this medicinal treatment. Major side effects include dry mouth, sedation, headaches, insomnia, sexual side effects, lowering of blood pressure, rash, nausea and cardiovascular disorders. One of the more serious side effects is called Tardive Dyskinesia that is a syndrome that consisting of potentially irreversible involuntary movements of the body. It seems to happen most often among elderly women, but it is not possible to determine ahead of time which patient will develop it. MAOI’s are not prescribed as much as other antidepressants due to the fact that interaction with foods and other medications can cause hypertensive crisis, meaning the patient’s blood pressure goes extremely high and could be fatal. Foods that cause this dangerous interaction include cheese, alcohol, and certain aged meats. Drugs decongestions (like Sudafed), and other medications also run the risk of hypertension (Kastrup et. al 1069). Why would a person want to take antidepressants at the risk of developing these horrible side effects? Depression is a serious medical condition that can disrupt a person’s daily life. It can be mildly disruptive, or it can be extremely disruptive and in some cases turn people suicidal. Some symptoms of depression include feeling hopeless, worthless, guilty, and extremely tired; it also causes a loss of interest and pleasure in activities. Therefore, a depressed person would try anything to get back to achieve respite, or feel better for the first time in their life. It is comforting to believe that depression can be fixed by taking medication every day. In extreme cases, people are forced to be hospitalized or placed in institutions for depression. This idea became known as the medical model. People began to perceive individuals with mental disorders as suffering with an illness. People started to believe that mental disorders could be treated the same way as any other sickness; with medication. Today a number of states have programs that forcefully hospitalize individuals perceived to be at risk to themselves. In these instances, they undergo a comprehensive psychiatric evaluation and receive medication to alleviate this malaise. However, there is reason to believe that medication may not be the right solution for depression for everyone. While the idea of taking medication is mentioned to a depressed patient by their psychiatrist, therapist or medical professional, it does not always work for everyone. Fortunately, there is another alternative to medication referred to as psychotherapy that is based on principles of talking to a depressed patient 1-2 times a week and helping them find ways to get out of depression. Psychotherapy can be just as effective as medication and doesn’t run the risk of any side effects. Louis Joylon West, a professor of psychiatry at the UCLA School of medicine wrote: “Every symptom of depressive illness can be manifested in certain cases of bereavement. Treatment should be based on the principles of integrated psychotherapy with special considerations and areas of interest” (James et al. 113). Psychotherapy is different for every patient, but a similar fact is that all patients in psychotherapy put a little or a lot of effort in overcoming their depression. Are depressed patients really making an effort by just taking medication and not seeing a therapist? In this day and age, psychotherapy it is not used as much on depressed patients as medication. “Psychotherapy accounts for only 8 percent of dollars spent on mental health. The majority of the money is being spent on office calls for the prescribing and monitoring of drugs.”(Murray 13). Medication may seem like an easy way out of depression, but 17 percent of people taking Prozac discontinued treatment because of side effects, and 31 percent of patients taking tricyclic antidepressants stopped treatment because of side effects (Murray 5). Is it really worth the risk? The idea that medication can correct depression by fixing brain chemistry is only a theory. There are many natural ways for people to raise their serotonin levels in their brain just like medication supposedly does. Exercise, meditation and yoga are great natural serotonin boosters. Making healthy lifestyle changes and practicing optimistic thinking can also help depression. Medication should not be looked at as the only way out of depression. Nursing Considerations While there are a diverse number of pharmacotherapy options for individuals with depression the time most prevalent are drugs of the class considered SSRIs and MAOIs. The relative effectiveness and roles of these medicinal options was indicated earlier, but when considering the physiological concerns as well as the assessment and diagnosis criteria they are very much related. One of the most important considerations to keep in mind involves drug-drug interactions related to the concomitant use of SSRIs and MAOs; scientists refer to the negative effects of this combination as serotonin syndrome or toxidrome. In some instances the combination of different classes of anti-depressants is permitted and beneficial; as the exact function of the drugs is unknown the psychiatric goal in these instances is to attempt to target diverse brain functions through diverse medicinal supplements. There have been a number of allergies associated with different classes of anti-depressant medications. The number is so diverse that prescribing medication is accomplished greatly through a trial and error procedure. In some instances doctors have noted that cases of cutaneous reactions have occurred in response to SSRI consumption; in these instances, it’s necessary to change the medicinal approach. While there are minimum drug-food interactions associated with the consumption of anti-depressant medications, research notes that it is highly important for individuals to avoid alcohol and other stimulants when taking anti-depressants as they consistently demonstrate adverse reactions. When evaluating patients already on anti-depressant medication it’s necessary to monitor the complex relation of the patient’s symptoms, the side-effects experienced, and outside medications they are currently taking. As previously indicated there is a complex interaction that occurs with the individual’s biochemistry and physiology that complicates establishing outside objective prescriptive policies; in this regard constant monitoring and effective evaluative practice is essential in establishing a viable treatment plan. In all instances, it’s necessary that the individual begin on low dosages, as heart burn and nausea is a common occurrence when the body is overburdened with too high a dosage. For the majority of classes of anti-depressants absorption rates are fairly consistent with regularly established digestive functions; there are some drugs that cause varying degrees of sleep/wakefulness and the patient needs to be cognizant accordingly. Finally, it generally takes 4-6 weeks for the body’s biochemistry to adapt to the anti-depressant and for it to achieve full effectivity, although the side-effects and potential deleterious reactions can occur much earlier. Conclusion As one can see the scientific understanding of depression has evolved from an only partially understood element of the mind to its contemporary primacy as an area of major concern and treatment within the field of psychiatry. While there are a number of different classes of medicinal options for depression treatment, and countless generic brands, two of the most common classes of treatment include SSRIs and MAOIs. There are many side-effects and evaluation concerns that medical professionals must consider when prescribing any class of anti-depressants; this fact is compounded by the understanding that prescribing anti-depressant medication is greatly a trial and error process. Finally, while anti-depressants are effective for most, some individuals respond better to talk therapy options, or a combination of the two treatments. References Hales, Phillip C. et. al. Abnormal Psychology Boston: Houghton Mifflin Company,1995. James, Anthony E. MD, et. al. Managing Depression. New York: Hatherleigh Publishing, 1996. Kastrup, Erwin K. et. al. Drug Facts and Comparisons Maryland: Facts and Comparisons, 2003. Murray, Michael T. ND. ‘Natural Alternatives To Prozac’. New York: William Morrow and Company Inc. 1996. Zimbardo, Phillip G. et. al. Psychology 106. Boston: Pearson Custom Publishing, 2003. Zimbardo, Phillip G. et. al. Psychology 106. Boston: Pearson Custom Publishing, 2003. Read More