Esketamine (Spravato) is a unique medicine originally developed as an anesthetic and thought to treat depression though its effects on a brain chemical called glutamate. It is administered as a nasal spray and is for use in those who have not responded to treatment by other antidepressants. Its most common side effects include sedation, dissociation (having strange perceptions about time and space, or feeling as if things around you are not real), problems with thinking, and high blood pressure. If any of these side effects occur they are usually mild and temporary.
Different neuropsychiatric illnesses seem to be associated with an overabundance or a lack of some of these neurochemicals in certain parts of the brain. For example, a lack of dopamine at the base of the brain causes Parkinson's disease. There appears to be a relation between Alzheimer's dementia and lower acetylcholine levels in the brain. The addictive disorders are under the influence of the neurochemical dopamine. That is to say, drugs of abuse and alcohol work by releasing dopamine in the brain. The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the dopamine system, which means that the system gets used to the effects of drugs and alcohol. Therefore, a person needs more drugs or alcohol to achieve the same high feeling (builds up tolerance to the substance). Thus, the addicted person takes more substance but feels less and less high and increasingly depressed. There are also some drugs whose effects can include depression (these include alcohol, narcotics, and marijuana) and those for whom depression can be a symptom of withdrawal from the substance (including caffeine, cocaine, or amphetamines).

Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. (Remember that brain serotonin levels often are low in depression.) As their name implies, the SSRIs work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) connect to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.

The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.


While the majority of individuals with depression have a full remission of the disorder with effective treatment,only about a third (35.3%) of those suffering from severe depression seek treatment from a mental health professional.[2]  Too many people resist treatment because they believe depression isn't serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.

Antidepressants are usually taken daily. The goal in the first few weeks and months is to relieve the symptoms and, if possible, make the depression go away. Once that has been achieved, the treatment is continued for at least four to nine months. This continuation therapy is necessary to stop the symptoms from coming back. The medication is sometimes taken for longer to prevent relapses. The duration of treatment also depends on how the symptoms develop over time and whether there is an increased risk of relapse. Some people take antidepressants for several years.
Venlafaxine and its active metabolite inhibit neuronal serotonin and norepinephrine reuptake. They are weak inhibitors of dopamine reuptake. In addition, it causes beta-receptor down-regulation. Venlafaxine is sometimes prescribed for non–FDA-approved indications, such as obsessive-compulsive disorder, hot flashes, neuropathic pain, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder.

The Cochrane Collaboration reviewed 34 studies that compared exercise interventions with various control conditions in the treatment of fibromyalgia. The reviewers concluded that aerobic exercise, performed at the intensity recommended for maintaining heart and respiratory fitness, improved overall well-being and physical function in patients with fibromyalgia, and might alleviate pain. More limited evidence suggests that exercises designed to build muscle strength, such as lifting weights, might also improve pain, overall functioning, and mood.

If you think you may have depression, describe your symptoms to a doctor. Or, if you’re not able to do that, pull out your cell phone and type “depression” or “clinical depression” into Google; you’ll be able to take a clinically validated depression test, known as the PHQ-9 patient health questionnaire, immediately and see if your scores show that you have depression.


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When in the depressed cycle, the person can experience any or all of the symptoms of a depressive condition. When in the manic cycle, any or all of the symptoms listed later in this article under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, indiscriminate or otherwise unsafe sexual practices or unwise business or financial decisions may be made when an individual is in a manic phase.
Physicians continue to investigate how to most effectively make treatment of depression available and acceptable to all who need it. This is particularly important for children and adolescents, minorities, individuals who are economically disadvantaged or live in rural areas, the elderly and for people with developmental disabilities, who suffer from lack of adequate access to mental health treatment that is knowledgeable and respectful of what may be their unique needs and preferences. While sadness will always be part of the human condition, hopefully we will be able to lessen or eradicate the more severe mood disorders from the world to the benefit of all of us.
I have also suffered a recent brain injury (concussion). Medication is not an option for my panic and anxiety symptoms. I am now taking cranio- sacral therapy providing significant relief. How I recovered from my horrific addiction to phsyco meds 10 years ago is still a very painful memory not to be easily forgotten. I am convinced & am choosing a holistic safer route instead of the dead end road of pharmaceutical therapy. God Bless. Julie
Mirtazapine (Remeron), another antidepressant, is a tetracyclic compound (four-ring chemical structure). It works at somewhat different biochemical sites and in different ways than the other medications. It affects serotonin but at a postsynaptic site (after the connection between nerve cells). It also increases histamine levels, which can cause drowsiness. For this reason, patients take mirtazapine at bedtime; physicians often prescribe mirtazapine for people who have trouble falling asleep. Like the SNRIs, it also works by increasing levels in the norepinephrine system. Other than causing sedation, this medication has side effects that are similar to those of the SSRIs.
^ Jeronimus BF, Kotov R, Riese H, Ormel J, et al. (October 2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.

Researchers once thought the relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
Researchers are studying natural and complementary treatments (add-on treatments to medicine or therapy) for depression. Currently, none of the natural or complementary treatments are proven to work as well as medicine and therapy for depression. However, natural or complementary treatments that have little or no risk, like exercise, meditation, or relaxation training, may help improve your depression symptoms and usually will not make them worse.
Monoamine oxidase inhibitors (MAOIs) were among the earliest treatments for depression. The MAOIs block an enzyme, monoamine oxidase, that then causes an increase in brain chemicals related to mood, such as serotonin, norepinephrine and dopamine. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch). Although MAOIs work well, they're not prescribed very often because of the risk of serious interactions with some other medications and certain foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.
Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Researchers once thought the relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
The birth of a baby can trigger mood swings or crying spells in the following days or weeks, the so-called baby blues. When the reaction is more severe and prolonged, it is considered postpartum depression, a condition requiring treatment because it can interfere with the ability to care for the newborn. Depression can also occur seasonally, primarily in the winter months when sunlight is in short supply. Known as seasonal affective disorder, or SAD, it is often ameliorated by daily exposure to specific types of artificial light.
Amitriptyline inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal membrane, which increases concentration in the CNS. It has a high affinity for histamine H1 and muscarinic M1 receptors. Amitriptyline can cause weight gain, sedation, and anticholinergic side effects. It is often used for non–FDA-approved indications, such as chronic pain management, diabetic neuropathy, migraine prophylaxis, and posttraumatic stress disorder.
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.
The most commonly diagnosed form of depression is Major Depressive Disorder. In 2015, around 16.1 million adults aged 18 years or older in the U.S. had experienced at least one major depressive episode in the last year, which represented 6.7 percent of all American adults. Depression is the leading cause of disability in the United States among people ages 15-44.  View the NIMH website for statistics from the 2016 National Survey on Drug Use and Health
It's also common for people who are having a difficult time with an anxiety disorder to feel depressed as a result of the way anxiety is interfering with their lives. It's my experience that most patients who experience this will find that their depression lifts naturally as a result of doing better with anxiety, and no special treatment for the depression is necessary.
Left untreated, depression can be a debilitating illness for individuals and their families. Often, symptoms are not recognized for their severity and can worsen, and severe depression may lead to suicidal thoughts and actions. Common treatments for depression include individual and group therapy, and medications as appropriate. Other treatments may include TMS (transcranial magnetic stimulation) and ECT (electroconvulsive therapy), both of which have been found to have profound effects on individuals with depression, especially for those who have not found relief in symptoms through other treatment methods.
Dr. John Grohol is the founder, Editor-in-Chief & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member and treasurer of the Society for Participatory Medicine. He writes regularly and extensively on mental health concerns, the intersection of technology and psychology, and advocating for greater acceptance of the importance and value of mental health in today's society. You can learn more about Dr. John Grohol here.
On the other end of the spectrum, researchers are exploring a salvage medication for people with suicidal depression: ketamine, a street drug that can induce hallucinations and out-of-body experiences but that can also provide astonishingly swift relief from depression. Ketamine is currently undergoing clinical trials; meanwhile, physicians warn that this drug can be abused.
Can depression actually be successfully treated? The short answer is yes. According to the National Institute of Mental Health and countless research studies over the past six decades, clinical depression is readily treated with short-term, goal-oriented psychotherapy and modern antidepressant medications. For most people, a combination of the two works best and is usually what is recommended. Psychotherapy approaches scientifically proven to work with depression include cognitive-behavioral therapy (CBT), interpersonal therapy, and psychodynamic therapy (Gelenberg et al., 2010). Psychotherapy is one of the most effective treatments for all types of depression and has very few side effects (and is a covered treatment by all insurers).
Over the years, the technique of ECT has improved from the procedure that still invokes stigma in the minds of many. Physicians administer the treatment in the hospital under anesthesia so that people receiving ECT do not hurt themselves or feel emotional or physical pain during the induced seizures or at any other time. Most patients undergo six to 10 treatments. A health care professional passes an electrical current through the brain to cause a controlled seizure, which typically lasts for 20-90 seconds. The patient is awake in five to 10 minutes. The most common side effect is short-term memory loss, which usually resolves quickly. Doctors safely perform ECT as an outpatient procedure.
Connect with others. It’s common to withdraw when you’re feeling depressed, but this can make you feel worse. Try to reconnect with friends. Again, make your goal realistic: if you’ve been avoiding your friends altogether, a starting point might be to send a text or (finally) to reply to one. If you don’t feel like leaving the house, you could ask them to come and hang out with you at home.
To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.
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