Category Archives: OCD

Severe Depression

Severe depression: is there a best approach?
Sonawalla SB, Fava M.
Depression Clinical and Research Program,
Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts, USA
CNS Drugs 2001;15(10):765-76
severe depression


A major depressive episode can be categorised as severe based on depressive symptoms, scores on depression rating scales, the need for hospitalisation, depressive subtypes, functional capacity, level of suicidality and the impact that the depression has on the patient. Several biological, psychological and social factors, and the presence of comorbid psychiatric or medical illnesses, impact on depression severity. A number of factors are reported to influence outcome in severe depression, including duration of illness before treatment, severity of the index episode, treatment modality used, and dosage and duration of and compliance with treatment. Potential complications of untreated severe depression include suicide, self-mutilation and refusal to eat, and treatment resistance. Several antidepressants have been studied in the treatment of severe depression. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, serotonin 5-HT(2) receptor antagonists, monoamine oxidase inhibitors, and amfebutamone (bupropion). More recently, atypical antipsychotics have shown some utility in the management of severe and resistant depression. Data on the differential efficacy of TCAs versus SSRIs and the newer antidepressants in severe depression are mixed. Some studies have reported that TCAs are more efficacious than SSRIs; however, more recent studies have shown that TCAs and SSRIs have equivalent efficacy. There are reports that some of the newer antidepressants may be more effective than SSRIs in the treatment of severe depression, although the sample sizes in some of these studies were small. Combination therapy has been reported to be effective. The use of an SSRI-TCA combination, while somewhat controversial, may rapidly reduce depressive symptoms in some patients with severe depression. The combination of an antidepressant and an antipsychotic drug is promising and may be considered for severe depression with psychotic features. Although the role of cognitive behaviour therapy (CBT) in severe depression has not been adequately studied, a trial of CBT may be considered in severely depressed patients whose symptoms respond poorly to an adequate antidepressant trial, who are intolerant of antidepressants, have contraindications to pharmacotherapy, and who refuse medication or other somatic therapy. A combination of CBT and antidepressants may also be beneficial in some patients. Electroconvulsive therapy (ECT) may be indicated in severe psychotic depression, severe melancholic depression, resistant depression, and in patients intolerant of antidepressant medications and those with medical illnesses which contraindicate the use of antidepressants (e.g. renal, cardiac or hepatic disease).

Menopause And Depression

Why am I depressed?

Depression affects twice as many women as men. Midlife is often considered a period of increased risk for depression in women. It is not known why, but it may be related to having a personal or family history of depression, life stressors, and role changes. Menopause is often believed to be a time when women are more likely to become depressed. Studies actually show that menopause depression is more likely to occur in the years during transition to. This period is associated with gradual declines in estrogen levels. Some studies suggest that changes in estrogen levels are associated with onset of menopuase depression.
Menopause depression

What are the symptoms of depression during midlife?

The symptoms of depression in pregnancy are: two or more weeks of depressed mood, decreased interest or pleasure in activities, change in appetite, change in sleep patterns, fatigue or loss of energy, difficulty concentrating, excessive feeling of guilt or worthlessness, thoughts of suicide, extreme restlessness and irritability. Many symptoms of menopause overlap with symptoms of depression including problems with sleep, physical symptoms such as hot flashes, fatigue, irritability, anxiety and difficulty concentrating. Some women suffer needlessly because they think these discomforts and problems are a natural part of aging. Depression should not be dismissed as a normal consequence of later life for women.

Depression that goes untreated can lead to more severe episodes of depression and even physical complications. For example, depression is associated with increased risk for heart attacks. A recent study suggests that depression leads to loss of bone mineral density, therefore increasing a women’s risk for broken bones.

What is menopause?

Menopause is the time in life when a woman stops having menstrual periods. All women who live long enough will eventually experience menopause. The average age for menopause is 51. As a woman approaches menopause, her body gradually makes less estrogen and progesterone hormone. As a result, most women have symptoms such as hot flashes, vaginal dryness, lower sex drive, urinary incontinence, and depression. Less common symptoms include sleep disorders, dry skin, mood swings, and fatigue.

ertain health problems, such as osteoporosis (brittle bones) and increased heart disease, are associated with menopause. To help prevent such problems, many women choose to take an estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) to replace what their body is no longer producing. Along with over the counter products, this is the primary treatment for the symptoms of menopause.

Lifestyle changes can also help relieve or prevent menopausal symptoms. Avoiding alcohol, caffeine, and spicy foods can help prevent hot flashes. Keeping cool and dressing in loose layers of natural fabrics such as cotton can help reduce the discomfort of a hot flash. Kegel exercises can strengthen pelvic muscles, preventing urine leaks and improving bladder control. Regular exercise can help prevent osteoporosis and heart disease. It can also lessen symptoms of menopause depression.

Depression in Children

What is depression Anxiety Disorder?

I have written this page in an effort to give you an overview of anxiety and anxiety disorders. You will find information on what anxiety is, what causes anxiety disorders, symptoms of anxiety and anxiety treatment methods that can help. In addition, you can find definitions for the most common types of anxiety disorder. Hopefully, this will help you to identify what is making you feel the way you do, and you can begin to find relief for your dilemma.

Over 18 million people suffer from anxiety disorder. You CAN find help! About 9 in 10 individuals who seek anxiety treatment report feeling better.

Although there are many different forms of anxiety disorders (and anxiety treatment), the general definition for anxiety is:

“a vague, unpleasant and sometimes debilitating emotion that is experienced in anticipation of some misfortune. ”

The misfortune is usually ill-defined, meaning that it is hard to pinpoint the actual reason for what is causing the anxiety. Although many people suffer from anxiety in certain situations, the reasons for why they feel the way they do are generally difficult to identify. Most people understand that they have anxiety. What is difficult to understand is WHY the anxiety has such a strong hold on their life. If you are experiencing anxiety, keep reading and you will find a list of common anxiety disorders in this section. Identifying what type of anxiety you have and why it is happening is the first step in finding effective anxiety treatment.

Depression anxiety

The Causes of Anxiety

The cause of anxiety disorder has been studied for decades. There are various reasons for feeling the way that you do. First, it is important to understand which form of anxiety disorder you may have. Researchers have been studying the effects of anxiety on the brain and have found much insight into how it effects us. Modern studies indicate that as a result of past, present or perceived circumstances that occurred to an individual, a chemical imbalance may have occurred in the brain. The emotions we feel are based on the release and reuptake of neurotransmitters in the brain. This is how cells within the brain communicate. Feelings off anxiety are triggered by an imbalance of specific ‘neurochemicals’ in the brain. The specific neurotransmitters that may be affected include serotonin, norepinephrine, GABA and dopamine.

When we feel stressed, anxious or depressed, our brains may be releasing or absorbing (re-uptake) chemicals either too rapidly or too slowly. If left untreated, a chemical imbalance disorder may increase in severity as time passes.

Most modern methods for treating chemical imbalances come in the form of prescription medications. Drugs like Paxil, Prozac and Effexor are believed to have a direct effect on key neurotransmitters. Though these drugs work in about 60% of individuals who take them, patients often report experiencing a wide variety of side effects, and the drug manufacturers themselves aren’t even sure how the drugs actually work to ‘rebalance’ chemicals in the brain. Users of these drugs often report relapse, as the drugs fail to address the underlying causes of anxiety.

The question that needs to be answered before doctors move too hastily in prescribing medications to their patients is : What is the cause of the chemical imbalance?

Depression anxiety

The Cause of Chemical Imbalance

Some theories suggest that chemical imbalances are a normal part of life. Everyone feels stressed or anxious at times, even depressed. This is a normal response by our body to events occurring around us. It is important to note that the physical or mental feelings we experience and exhibit are being caused by the release of chemicals and hormones in our brains.

Example 1a:

As you prepare your schedule for the week, your manager comes into your office and tells you that you need to have a new certification program written and developed for incoming new-hires by the end of the week. “This is a critical part of our new-hire training, and I need it done by Friday, or my boss will have my head… and I’ll have yours!”, he says to you. [maybe not so dramatic]

You reluctantly agree and ensure your manager that you will have the work completed.. As soon as your manager leaves your office, you begin to experience feelings of stress and nervoussness. “I can never finish this…..what is he thinking?……It’s too much work…. I haven’t even started….. I am going to get fired,” and similar thoughts echo through your mind repeatedly for the next 10 minutes. You can feel a headache coming on, you start thinking of worst case scenarios, your face begins to flush, your heart begins to beat more rapidly….. you become angry. “How can he spring this on me with such short notice!”

In the above example, your body begins to physically respond to your overwhelming thoughts of what might and could go wrong. A common occurrence, this often happens in stressful situations because our brain begins to overload our body with unbalanced releases of neurotransmitters and other brain chemicals. If we are unable to get rid of the feelings, they progressively worsen over the course of the day, or week, or month.

Example 1b:

You begin thinking about some cognitive behavior therapy exercises you learned to help you cope with your stress and anxiety. You realize that your thoughts are causing you to continue to create irrational thinking patterns, which in turn, is causing you to feel physical symptoms of stress and anxiety

“I have been writing training material for years. I bet if I check all of the resources I already have, I can find some things that can help me get this project completed. I am a professional, and I have successfully handled these deadlines before.”

You provide yourself with evidence that you are not helpless in this situation, and that chances are, if you organize yourself, you can get this done. Over the course of 5 – 15 minutes, you reinforce yourself with overwhelming reasons for why you can do it. You begin to take notes and jot down plans for the project.

As you begin to cope with the stresses that presented themselves, your body starts returning to normal chemical states. Physical, and emotional symptoms begin to diminish. You are able to cope with the stress.

In most cases, we are able to develop coping techniques that can help us to immediately deal with the stress and the imbalance of chemicals that happen as a result. However, if we do not cope with the stresses that present themselves today, our negative feelings, emotions and thoughts take hold and might never let go.

Though the examples provided above are very basic, they demonstrate an approach to resolving anxiety based on addressing the underlying causes. Chemical imbalances may very well be caused by the fact that we have not yet found ways to cope with our underlying problems. Over time, the imbalance may become our brain’s normal setting, thus causing stress, anxiety or depression consistently, and for long periods of time.

Depression anxiety

Common Symptoms of Anxiety

Anxiety is an unpleasant and sometimes debilitating emotion that is experienced in anticipation of some form of disaster. It is sometimes difficult to diagnose properly because the symptoms of anxiety are also symptoms shared by other conditions, or symptoms that can occur without any condition at all.

Anxiety, once diagnosed, spawns many different symptoms, including

  • sleeping troubles
  • specific obsessions over stressful topics
  • difficulty thinking about anything besides a stressful topic
  • feeling tense, restless, jittery, or dizzy.
  • having trouble concentrating
  • fluctuations in appetite
  • being overly cautious
  • being startled easily
  • having an omnipresent feeling of impending danger or disaster.

At times, individuals with anxiety may have feelings that cross-over into related conditions such as social anxiety, panic attacks and generalized anxiety disorder.

The symptoms of anxiety can present a person who suffers from them with major obstacles in his or her day-to-day life. Anxiety symptoms can seem to bring a person down and keep them down. This creates a feeling of immense pressure on the individual. However, the symptoms of anxiety can be relieved with the proper treatment so that a person who experiences them can live a normal and productive life. Learning more about yourself, your feelings and what may be causing the stresses in your life is an important step to finding a long-term solution.