SEASONAL DEPRESSION

Chronic major depression is also associated with high rates of comorbidity with other mental illnesses, in particular anxiety disorders, substance abuse, and personality disorders, as well as medical disorders such as coronary artery disease and strokes.

Major depression goes largely unrecognized and under treated .On the flip side there are some theorist that believe that depression is over diagnosed and that lowering the threshold for depression diagnosis risks leading to treatment of normal emotional states as illness. However, that thinking has been rejected by the majority of the mental health professions because most normal sadness does not present for treatment.

Once the diagnosis of depression is made the patient is then treated with medications or a combination of medications and psychotherapy .The goal is to alleviate the patients’ depression and have increased functionality.

There are many different medications available for treatment-the most commonly used are the SSRI’s e.g. Zoloft, Prozac, Paxil, Celexa etc, then there is another class of antidepressants known as SNRI’s e.g. Venlafaxine and Wellbutrin. Some of the older antidepressants known as the Tricyclic Antidepressants are still being used in patients that are resistant to the above, however they do have more side effects. Another group of antidepressants are the MAOI’s which are very effective but also have more side effects and have dietary restrictions .The last two are more dangerous and can result in overdose if one is not careful. If a patient does not respond to any of the above medications they can still be treated with ECT or electroconvulsive therapy which is a very effective and safe treatment but is not very popular.

Depression is also common in children and since the 2002 FDA warning label on the antidepressants warning people of increased risks of suicide with antidepressants went into effect, the prescription of antidepressants to children has decreased. Has that prevented suicides? You might be surprised to know that the rate of suicide has actually increased because the children are not getting treated .Parents are opting not to treat and some doctors do not want the hassle of being sued. Depression as a disease has a high incidence of suicide and almost 60% of the suicides occur during an episode of mood disorder.

How about depression and pregnancy? This is an area that needs an enormous amount of collaboration with your doctor. Prevalence of depression range from 10% to 25 % in community samples for childbearing women. Most patients have difficulty getting pharmacological help during this time as most doctors are very wary of prescribing antidepressants at that time and women sometimes have to choose between medication and the baby. One needs to be better informed about the choices because these two are really not is not options.

Patients should actively participate in treatment selection and monitoring. For patients with recurrent major depression defined as more than 3 lifetime episodes, the risks of another episode without maintenance treatment is high, with median time to recurrence of 21 weeks. Maintenance interpersonal psychotherapy has been shown to increase median recurrence time to 54 weeks. The different treatment options during pregnancy are: Somatic therapy: ECT has been used safely and successfully during pregnancy. Other treatments such as partial sleep deprivation and rapid transcranina magnestic stimulation has been proposed .Light therapy has also been used. Psychotherapy: Interpersonal psychotherapy with focus on role change and interpersonal functioning is helpful during pregnancy. No treatment: Monitoring can be recommended for evaluation of urgent situations for example-suicidality, deteriorating social and physical function and inability to comply with obstetric follow up.

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