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Depression

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Depression in Our Current Culture

Women in the United States and in other countries around the world have been reported to experience depression about twice as often as men. However, it is important to note that men are less likely than women to admit to their emotional pain and depression. According to the National Institute of Mental Health about three to four million men in the United States suffer from Major Depression but because of societal stigma, embarrassment and denial, men are less likely to be diagnosed with depression. Therefore we can assume that these numbers are most likely much larger and not an accurate reflection of depression in our current culture.

While for serious depressions, medication is advisable; it has never been shown to be effective in and of itself. All research thus far shows that anti-depressant medications are only effective when coupled with psychotherapy to prevent depression from reoccurring.

 

 

Depression

A Quick Check List of the Signs and Symptoms of Depression

  • Overall feeling of apathy
  • Changes in appetite
  • Changes in sleeping habits
  • Changes in daily routines and physical activity
  • Reactions of irritation or heightened sensitivity toward others
  • Loss of energy and participation in things which had given you joy in the past
  • Reoccurring memories of guilt related to friends and family
  • Feelings of helplessness
  • Fewer thoughts, sometimes distracted and unable to think things through
  • Sense of your horizon shrinking, feeling defeated
  • Wondering about the worth of your life
  • Ruminating on whether you would be missed or not
  • Thoughts of suicide

If four or five of these symptoms seem descriptive of your self-experience you are most likely experiencing a depression and should seek a consultation with a doctor.

 

 

Hormones, Stress and Mood Disorders: Different in Men and Women?

Hormones, including those related to our sexuality, significantly affect mood and brain functioning. Women respond to stress differently than men and are twice as likely to suffer from Major Depressive Disorder. Female depression is characterized by longer episodes, higher numbers of recurrent episodes, and greater levels of severity compared to depression seen in males. However, these differences diminish after menopause when female hormones no longer undergo significant cyclic changes. Female depression has been suggested to be different from male depression in significant ways. Male depression is more associated with abnormalities in adrenal stress hormones while female depression is more related to ovarian sex hormone changes.

The levels of the ovarian hormones estrogen and progesterone contribute to higher levels of depression in women. Female depression often occurs during periods of hormonal changes prior to menses, immediately after pregnancy and during and shortly after menopause. For example, post-partum depression is associated with low levels of estrogen. It is seen in 10% of new mothers and is still present six months later in 30% of them. Premenstrual dysphoric disorder (PMDD) in the luteal phase of the menstrual cycle is a severe syndrome of depression, anxiety and irritability seen in 5% of women of reproductive age. Perimenopause, the 10-year period proceeding menopause when hormone levels begin to change, results in higher rates of depression in about 10% of women. Mood disturbances during this time may contribute to the hot flashes, insomnia and fatigue commonly experienced during this time. Menopause results in a reoccurrence of depressive symptoms in women who have a history of depression. Treatment with low dose estrogen in small studies has been shown to reduce or relieve symptoms of depression in a significant percentage of menopausal women.

Sources:
Avis, NE, McKinley SM, JAMA, 1995. 50: 45-49.
Buckwalter JG et al, Prog Brain Res, 201, 133: 303-319.
Burt VK et al. Harv Rev Psychiatry Assn, 1998, 6:121-132.
Cook IA, Joffe H, Ann Mtg of Am Psychiatry Assn, 2005.
Richardson TA, Robinson RD, Prim Care Dudate Ob-Gyn, 2000, 7:21-223.
Rubinow DR, JAMA, 1992, 268: 1908-1912.
Shors TJ, Leuner BJ, Affect Disorders 2003, 74:85-96.

 

 

Hormones & Mood Disturbances: Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that afflicts about 5 percent of women in the childbearing years. It begins during the later luteal phase of the menstrual cycle a few days before menses and usually disappears within a few days after onset of menses. Significant anger, anxiety, and depression can appear in PMDD at severity levels markedly greater than PMS to the point that there is significant impairment in daily functioning and treatment is required. PMDD has symptoms that resemble panic disorder, generalized anxiety disorder, and depression. PMDD has been proposed as a formal, unique mood disorder in the current Diagnostic and Statistical Manual-IV-TR of the American Psychological Association. There may be subtypes of the disorder that more resemble either anxiety or depression.

The disorder has been linked to cyclic disruption of brain serotonin levels due to the fluctuation of the sex hormones (estrogen, progesterone, and testosterone) in the luteal phase of the menstrual cycle. Supporting this hypothesis are studies showing alleviation of PMDD symptoms by selective reuptake inhibitor (SSRI) antidepressant medications, which are now considered first-line therapy. Dosages can be continuous, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. Notably, fluoxetine (Prozac) has been repackaged as a PMDD specialty therapy under the trade name Sarafem. Among the SSRIs studied, sertraline has been shown in the largest number of studies to effectively reduce mood symptoms of PMDD. The SSRIs do not alleviate symptoms of PMDD in all women. Some recent studies have shown that an oral contraceptive containing the novel progestin drospirenone administered for 24 days in a 28-day cycle is effective in reducing symptoms in many women. Gonadotropin-releasing hormone (GnRH) and alprazolam are also used but less frequently.

Sources:
American Psychiatric Association, DSM-IV-TR 2000.
Futterman et al. J. Reprod. Med. 2006. 51:349-358.
Kroll et al. J. Reprod. Med. 2006. 51:359-370.
Landen et al. Depress. Anxiety. 2003. 17:122-129.
Steiner et al. Women’s Health. 2006. 15:57-69..

 

 
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