Clomipramine potently inhibits the reuptake of serotonin at the presynaptic neuronal membrane. It has strong affinities to both H1 and M1 receptors, which results in sedation, weight gain, and anticholinergic side effects. Although clomipramine is FDA approved only for obsessive-compulsive disorder, it has also been prescribed for depression, panic attacks, and chronic pain.
Atypical antidepressants include bupropion (Wellbutrin, Wellbutrin SR), mirtazapine (Remeron), and trazodone (Desyrel). These agents are effective in treating major depression and may be effective in combination therapy in major depressive disorder. This group also shows low toxicity in overdose. Wellbutrin SR may have an advantage over the SSRIs by causing less sexual dysfunction and weight gain.
Play is natural and fun for children and an important part of learning and development. Play therapy is a therapy used by licensed mental health professionals to help children to better express their thoughts and emotions and to address a variety of problems. When children are unable to put into words their feelings or concerns, play can help them express themselves and learn ways to cope.  
A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition and energy levels, but may also involve one or more episodes of depression.[22] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode;[23]:355 and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[24]
Scientists have some evidence that depression susceptibility is also related to diet, both directly—through inadequate consumption of nutrients such as omega-3 fats—and indirectly, through the variety of bacteria that populate the gut. Of course, depression involves mood and thoughts as well as the body, and it causes pain for both those with the disorder and those who care about them. Depression is increasingly common in children.
The key to living with depression is ensuring you’re receiving adequate treatment for it (usually most people benefit from both psychotherapy and medication), and that you are an active participant in your treatment plan on a daily basis. This requires a lot of effort and hard work for most people, but it can be done. Establishing new, healthier routines are important in many people’s management of this condition. Getting regular emotional support — for instance, through an online support group — can also be extremely beneficial.
Monoamine oxidase inhibitors (MAOIs) – MAOIs have more serious side effects, so they are rarely prescribed unless other medications do not work. MAOIs have many interaction effects with foods and other medications, so people who take them may have to change their diet and other medications. SSRIs and many other medications taken for mental illness cannot be taken with MAOIs.
For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 1% to 2% of the population, particularly women and young people. SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.
Nortriptyline blocks the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal membrane. It has less affinity for H1 and M1 receptors and, thus, is better tolerated than other TCAs. Although nortriptyline is FDA approved only for depression, it has also been prescribed for chronic pain, myofascial pain, anxiety disorders, and attention-deficit/hyperactivity disorder. As with desipramine, there is a therapeutic window for nortriptyline
Anxiety disorders are the most common type of mental disorder. 50-60% of migraine patients will suffer from an anxiety disorder. Most anxiety disorders involve chronic worry or fear and avoiding things that trigger these feelings. In panic disorder, the patient has recurrent, unexpected feelings of intense fear or terror that seem to come from out of the blue. The heart starts beating rapidly and breathing becomes strained. Other symptoms may involve sweating, fear of dying, or losing control. Although attacks don’t last very long and are not dangerous, many people develop significant anxiety between attacks and come to fear normal body sensations.
A person with anxiety disorder, however, experiences fear, panic or anxiety in situations where most people would not feel anxious or threatened. The sufferer may experience sudden panic or anxiety attacks without any recognized trigger, and often lives with a constant nagging worry or anxiousness. Without treatment, anxiety and depression disorders can restrict a person's ability to work, maintain relationships, or even leave the house.
Behavioral activation is the practice of gradually increasing activity to experience more pleasure and mastery in life, according to Joel Minden, Ph.D., a clinical psychologist at the Chico Center for Cognitive Behavior Therapy. The therapeutic technique is relatively new, so it has a limited amount of research backing it. Nonetheless, it did spring from cognitive behavior therapy [CBT], which has mountains of research to support its efficacy.
Monoamine oxidase also breaks down tyramine, a chemical present in aged cheese, wines, and other aged foods. Since MAOIs inhibit monoamine oxidase, they decrease the breakdown of tyramine from ingested food, increasing the level of tyramine in the body. Excessive tyramine can elevate blood pressure and cause a hypertensive crisis. Patients treated with MAOIs should adhere to recommended dietary modifications that reduce the intake of tyramine. Interestingly, the 6 mg/24 hour dose of selegiline transdermal system (EMSAM, and MAO inhibitor) does not require dietary restrictions because at this dose EMSAM does not substantially inhibit tyramine. Higher selegiline transdermal system (EMSAM) doses require dietary restrictions.
Serotonin syndrome: Serotonin syndrome is a serious medical condition that can occur when medications that alter the concentration of serotonin in the brain are taken together. Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. Examples of medications that can cause serotonin syndrome include antidepressants, some pain relievers such as meperidine (Demerol) or tramadol (Ultram), St. John's wort, medicines used to treat migraine headaches called triptans, and some street drugs such as cocaine.

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.


Suicidal behavior is defined as a preoccupation or act that is focused on causing one’s own death voluntarily. Suicidal ideation refers to thoughts of suicide or wanting to take one’s own life. Suicidal behavior refers to actions taken by one who is considering or preparing to cause his or her own death. Suicide attempt usually refers to an act focused on causing one’s own death that is unsuccessful in causing death. Suicide refers to having intentionally caused one’s own death. Talking about suicide is the best way to prevent it. Although it is not possible to predict suicide with any certainty, our best tool is recognition of the signs that many people exhibit when contemplating suicide. These three behaviors should prompt you to seek immediate help for you or a loved one: talking about wanting to die or to kill oneself; looking for a way to kill oneself, such as searching online or obtaining a gun; talking about feeling hopeless or having no reason to live. See the Resources section below for actions to take if you or someone you know needs help.
A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition and energy levels, but may also involve one or more episodes of depression.[22] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode;[23]:355 and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[24]
8. Check with your doctor before using supplements. "There's promising evidence for certain supplements for depression," Cook says. Those include fish oil, folic acid, and SAMe. But more research needs to be done before we'll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications.
Exercise. As mentioned above, regular vigorous physical exercise is thought to have an antidepressant effect. Exercise offers many other benefits as well, including general improvements to your health and an opportunity to socialize (e.g., in a gym or with teammates), or to be alone (e.g., on a bike or solitary hike). Exercise is also a great way to distract yourself from your thoughts as the need to attend to the physical demands of what you are doing tend to drive out self-critical thinking (at least for a little while). Check with your doctor before starting a new physical exercise program just to make sure your body is up to handling it.
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
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