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alt.support.depression FAQ Part 1[5]

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Archive-name: alt-support-depression/faq/part1
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07

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alt.support.depression FAQ
==========================


Introduction
------------

Alt.support.depression is a newsgroup for people who suffer from all
forms of depression as well as others who may want to learn more about
these disorders. Much the information shared in this newsgroup comes
from posters' experience as well as contributions by professionals in
many fields. The thoughts expressed here are for the benefit of the
readers of this group. Please be considerate in the way you use the
information from this group, keeping in mind the stigma of depression
still experienced in society today. 

The following Frequently-Asked-Questions (FAQ) attempts to impart an
understanding of depression including its causes; its symptoms; its
medication and treatments--including professional treatments as well as
things you can do to help yourself. In addition, information on where to
get help, books to read, a list of famous people who suffer from
depression, internet resources, instructions for posting anonymously,
and a list of the many contributors is included.

Updated and corrected versions will be posted periodically. Please send
suggestions to <cf12@cornell.edu>.

This FAQ, and many other FAQ's, are available via anonymous ftp from
<rtfm.mit.edu>. To get the latest edition of this FAQ:
ftp://rtfm.mit.edu/pub/usenet/news.answers/alt-support-depression/faq/part1

The directory and file name is located in the "Archive-name:" line in
the header. A mail server also exists for accessing the FAQ archives.
Send a message to <mail-server@rtfm.mit.edu>, with the command "help"
in the body of your message.


Table of Contents
=================

Key:
     - No change.
     + Added since last posting.
     & Updated since last posting.


Part 1 of 5
-----------

 **Depression Primer**

  **Types**
   - What is depression?
   - What is major depression?
   - What is dysthymia?
   - What is bipolar depression (manic-depressive illness)?
   - What is Seasonal Affective Disorder (SAD)?
   - What is Post Partum Depression
   - How is bereavement different from depression?
   - What is Endogenous Depression
   - What is atypical depression?

  **Symptoms**
   - What are the typical symptoms of depression?
   - What are the diagnostic criteria for depression?

  **Causes**
   - What causes depression?
  

Part 2 of 5
-----------

  **Causes** (cont.)
   - What initiates the alteration in brain chemistry?
   - Is a tendency to depression inherited?

  **Treatment**
   - What sorts of psychotherapy are effective for depression?

  **Medication**
   - Do certain drugs work best with certain depressive illnesses? What
     are the guidelines for choosing a drug?
   - How do you tell when a treatment is not working? How do you know
     when to switch treatments?
   - How do antidepressants relieve depression?
   - Are Antidepressants just "happy pills?"
   - What percentage of depressed people will respond to
     antidepressants?
   - What does it feel like to respond to an antidepressant? Will I
     feel euphoric if my depression responds to an antidepressant?
   - What are the major categories of anti-depressants?
   - What are the side-effects of some of the commonly used
     antidepressants?
   - What are some techniques that can be used by people taking
     antidepressants to make side effects more tolerable?
   - Many antidepressants seem to have sexual side effects. Can
     anything
     be done about those side-effects?
   - What should I do if my antidepressant does not work?


Part 3 of 5
-----------

  **Medication** (cont.)
   - If an antidepressant has produced a partial response, but has not
     fully eliminated depression, what can be done about it?

  **Electroconvulsive Therapy**
   - What is electroconvulsive therapy (ECT) and when is it used?
   - Exactly what happens when someone gets ECT?
   - How do individuals who have had ECT feel about having had the
     treatments?
   - How long do the beneficial effects of ECT last?
   - Is it true that ECT causes brain damage?
   - Why is there so much controversy about ECT?

  **Substance Abuse**
   - May I drink alcohol while taking antidepressants?
   - If I plan to drink alcohol while on medication, what precautions
     should I take?
   - What's the relationship between depression and recovery from
     substance abuse?
   - What does the term "dual-diagnosis" mean?
   - Is it safe for a person recovering from substance abuse to take
     drugs?
   - How do you know when depression is severe enough that help should
     be sought?

  **Getting Help**
   -Where should a person go for help?
   -Where can I find help in the United Kingdom?
   -Where can I find out about support groups for depression?
   -How can family and friends help the depressed person?

  **Choosing A Doctor**
   -What should you look for in a doctor? How can you tell if he/she
    really understands depression?

  **Self-care**
   - How may I measure the effects my treatment is having on my
     depression?

Part 4 of 5
-----------

  **Self-care** (cont.)
   - How can I help myself get through depression on a day-to-day
     basis?

  **Books**
   - What are some books about depression?

Part 5 of 5
-----------

  **Famous People**
   - Who are some famous people who suffer from depression and bipolar
     disorder?

  **Internet Resources**
   - What are some electronic resources on the internet related to
     depression?

  **Anonymous Posting**
   - How can I post anonymously to alt.support.depression?

  **Sources**
   - Sources

  **Contributors**
   - Contributors


Depression Primer
=================

Types
-----

Q. What is depression?

   Being clinically depressed is very different from the down type of
   feeling that all people experience from time to time. Occasional
   feelings of sadness are a normal part of life, and it is 
   that such feelings are often colloquially referred to as
   "depression." In clinical depression, such feelings are out of
   proportion to any    external causes. There are things in everyone's
   life that are possible causes of sadness, but people who are not
   depressed manage to cope with these things without becoming
   incapacitated.

   As one might expect, depression can present itself as feeling sad or
   "having the blues". However, sadness may not always be the dominant
   feeling of a depressed person. Depression can also be experienced as
   a numb or empty feeling, or perhaps no awareness of feeling at all.
   A depressed person may experience a noticeable loss in their ability
   to feel pleasure about anything. Depression, as viewed by
   psychiatrists, is an illness in which a person experiences a marked
   change in their mood and in the way they view themselves and the
   world. Depression as a significant depressive disorder ranges from
   short in duration and mild to long term and very severe, even life
   threatening.

   Depressive disorders come in different forms, just as do other
   illnesses such as heart disease. The three most prevalent forms are
   major depression, dysthymia, and bipolar disorder.


Q. What is major depression?

   Major depression is manifested by a combination of symptoms (see
   symptom list below) that interfere with the ability to work, sleep,
   eat; and enjoy once-pleasurable activities. These disabling episodes
   of depression can occur once, twice, or several times in a lifetime.


Q. What is dysthymia?

   A less severe type of depression, dysthymia, involves long-term,
   chronic symptoms that do not disable, but keep you from functioning
   at "full steam" or from feeling good. Sometimes people with dysthymia
   also experience major depressive episodes.


Q. What is bipolar depression (manic-depressive illness)?

   Another type of depressive disorder is manic-depressive illness, also
   called bipolar depression. Not nearly as prevalent as other forms of
   depressive disorders, manic depressive illness involves cycles of
   depression and elation or mania. Sometimes the mood switches are
   dramatic and rapid, but most often they are gradual. When in the
   depressed cycle, you can have any or all of the symptoms of a
   depressive disorder. When in the manic cycle, any or all symptoms
   listed under mania may be experienced. Mania often affects thinking,
   judgment, and social behavior in ways that cause serious problems and 
   embarrassment. For example, unwise business or financial decisions may
   be made when in a manic phase.


Q. What is Seasonal Affective Disorder (SAD)?

   SAD is a pattern of depressive illness in which symptoms recur every
   winter. This form of depressive illness often is accompanied by such
   symptoms as marked decrease in energy, increased need for sleep, and
   carbohydrate craving. Photo therapy - morning exposure to bright, full
   spectrum light - can often be dramatically helpful.


Q. What is Post Partum Depression?

   Mild moodiness and "blues" are very common after having a baby, but
   when symptoms are more than mild or last more than a few days, help
   should be sought. Post part depression can be extremely serious for
   both mother and baby.


Q. How is bereavement different from depression?

   A full depressive syndrome frequently is a normal reaction to the
   death of a loved one (bereavement), with feelings of depression and
   such associated symptoms as poor appetite, weight loss, and insomnia.
   However, morbid preoccupation with worthlessness, prolonged and
   marked functional impairment, and marked psychomotor retardation are
   uncommon and suggest that the bereavement is complicated by the
   development of a Major Depression. The duration of "normal"
   bereavement varies considerably among different cultural groups.


Q. What is Endogenous Depression?

   A depression is said to be endogenous if it occurs without a
   particular bad event, stressful situation or other definite, outside
   cause being present in the person's life. Endogenous depression
   usually responds well to medication. Some authorities do not consider
   this to be a useful diagnostic category.


Q. What is atypical depression?

  "Atypical depression" is not an official diagnostic category, but it
   is often discussed informally. A person suffering from atypical
   depression generally has increased appetite and sleeps more than usual.
   An atypical depressive may also be able to enjoy pleasurable
   circumstances despite being unable to seek out such circumstances.
   This contrasts with the "typical" depressive, who generally has
   reduced appetite and insomnia, and who is often unable to find
   pleasure in anything. Despite its name, atypical depression may in
   fact be more common than the other kind.


Symptoms
--------

Q. What are the typical symptoms of depression?

   A depressive disorder is a "whole-body" illness, involving your body,
   mood, and thoughts. It affects the way you eat and sleep, the way you
   feel about yourself, and the way you think about things. A depressive
   disorder is not a passing blue mood. It is not a sign of personal
   weakness or a condition that can be willed or wished away. People
   with a depressive illness cannot merely "pull themselves together" and
   get better. Without treatment, symptoms can last for weeks, months, or
   years. Appropriate treatment, however, can help over 80% of those who
   suffer from depression. Bipolar depression includes periods of high
   or mania. Not everyone who is depressed or manic experiences every
   symptom. Some people experience a few symptoms, some many. Also,
   severity of symptoms varies with individuals.

   Symptoms of Depression:

   * Persistent sad, anxious, or "empty" mood
   * Feelings of hopelessness, pessimism
   * Feelings of guilt, worthlessness, helplessness
   * Loss of interest or pleasure in hobbies and activities that you
     once enjoyed, including sex
   * Insomnia, early-morning awakening, or oversleeping.
   * Appetite and/or weight loss or overeating and weight gain
   * Decreased energy. fatigue, being "slowed down"
   * Thoughts of death or suicide, suicide attempts
   * Restlessness, irritability
   * Difficulty concentrating, remembering, making decisions
   * Persistent physical symptoms that do not respond to treatment, such
     as headaches, digestive disorders, and chronic pain

   Symptoms of Mania:

   * Inappropriate elation
   * Inappropriate irritability
   * Severe insomnia
   * Grandiose notions
   * Increased talking
   * Disconnected and racing thoughts
   * Increased sexual desire
   * Markedly increased energy
   * Poor judgment
   * Inappropriate social behavior


Q. What are the diagnostic criteria for depression?

   Depression comes in many forms and in many degrees. Below, you will
   find some of the most common depressive types, along with some of the
   diagnostic criteria from the DSM-III-R (the official diagnostic and
   statistical manual for psychiatric illnesses).

   **Major Depression:** This is a most serious type of depression. Many
   people with a major depression can not continue to function normally.
   The treatments for this are medication, psychotherapy and, in extreme
   cases, electroconvulsive therapy (ECT).

   Diagnostic criteria:
   A. At least five of the following symptoms have been present during
      the same two-week period and represent a change from previous
      functioning; at least one of the symptoms is either (1) depressed
      mood, or (2) loss of interest or pleasure. (Do not include
      symptoms that are clearly due to a physical condition, mood-
      incongruent delusions or hallucinations, incoherence, or marked
      loosening of associations.) 
      1. depressed mood most of the day, nearly every day, as indicated
         either by subjective account or observation by others
      2. markedly diminished interest or pleasure in all, or almost all,
         activities most of the day, nearly every day (as indicated
         either by subjective account or observation by others of apathy
         most of the time)
      3. significant weight loss or weight gain when not dieting (e.g.
         more than 5% of body weight in a month), or decrease or
         increase in appetite nearly every day
      4. insomnia or hypersomnia nearly every day
      5. psychomotor agitation or retardation nearly every day
         (observable by others, not merely subjective feelings of
         restlessness or being slowed down)
      6. fatigue or loss of energy nearly every day
      7. feelings of worthlessness or excessive or inappropriate guilt
         (which may be delusional) nearly every day (not merely self-
         reproach or guilt about being sick)
      8. diminished ability to think or concentrate, or indecisiveness
         nearly every day (either by subjective account or as observed
         by others)
      9. recurrent thoughts of death (not just fear of dying), recurrent
         suicidal ideation without a specific plan, or a suicide attempt
         or a specific plan for committing suicide
   B. (1) It cannot be established that an organic factor initiated and
      maintained the disturbance (2) The disturbance is not a normal
      reaction to the death of a loved one
   C. At no time during the disturbance have there been delusions or
      hallucinations for as long as two weeks in the absence of
      prominent mood symptoms (i.e..- before the mood symptoms
      developed or after they have remitted).
   D. Not superimposed on Schizophrenia, Schizophreniform Disorder,
      Delusional Disorder, or Psychotic Disorder

   **Dysthymia:** This is a mild, chronic depression which lasts for two
   years or longer. Most people with this disorder continue to function
   at work or school but often with the feeling that they are "just
   going through the motions." The person may not realize that they are
   depressed. Anti-depressants or psychotherapy can help.

   Diagnostic criteria:
   A. Depressed mood (or can be irritable mood in children and
      adolescents) for most of the day, more days than not, as indicated
      either by subjective account or observation by others, for at
      least two years (one year for children and adolescents)
   B. Presence, while depressed, of at least two of the following:
      1. poor appetite or overeating
      2. insomnia or hypersomnia
      3. low energy or fatigue
      4. low self-esteem
      5. poor concentration or difficult making decisions
      6. feelings of hopelessness
   C. During a two-year period (one-year for children and adolescents)
      of the disturbance, never without the symptoms in A for more than
      two months at a time.
   D. No evidence of an unequivocal Major Depressive Episode during the
      first two years (one year for children and adolescents) of the
      disturbance.
   E. Has never had a Manic Episode or an unequivocal Hypo manic
      Episode.
   F. Not superimposed on a chronic psychotic disorder, such as
      Schizophrenia or Delusional Disorder.
   G. It cannot be established that an organic factor initiated or
      maintained the disturbance, e.g., prolonged administration of an
      antihypertensive medication.

   **Adjustment Disorder with Depressed Mood:** This is the type of
   depression that results when a person has something bad happen to
   them that depresses them. For example, loss of one's job can cause
   this type of depression. It generally fades as time passes and the
   person gets over what ever it was that happened.

   Diagnostic criteria:
   A. A reaction to an identifiable psycho social stressor (or multiple
      stressors) that occurs within three months of onset of the
      stressor(s).
   B. The maladaptive nature of the reaction is indicated by either of
      the following: 
      1. impairment in occupational (including school) functioning or in
         usual social activities or relationships with others
      2. symptoms that are in excess of a normal and expectable reaction
         to the stressor(s)
   C. The disturbance is not merely one instance of a pattern of
      overreaction to stress or an exacerbation of one of the mental
      disorders previously described (in the entire DSM).
   D. The maladaptive reaction has persisted for no longer than six
      months.
   E. The disturbance does not meet criteria for any specific mental
      disorder and does nor represent Uncomplicated Bereavement.


Causes
------

Q. What causes depression?

   The group of symptoms which doctors and therapists use to diagnose
   depression ("depressive symptoms"), which includes the important
   proviso that the symptoms have manifested for more than a few weeks
   and that  they are interfering with normal life, are the result of an
   alteration in brain chemistry. This alteration is similar to
   temporary, normal variations in brain chemistry which can be
   triggered by illness, stress, frustration, or grief, but it differs
   in that it is self-sustaining and does not resolve itself upon
   removal of such triggering events (if any such trigger can be found
   at all, which is not always the case.)

   Instead, the alteration continues, producing depressive symptoms and
   through those symptoms, enormous new stresses on the person:
   unhappiness, sleep disorders, lack of concentration, difficulty in
   doing one's job, inability to care for one's physical and emotional
   needs, strain on existing relationships with friends and family.
   These new stresses may be sufficient to act as triggers for
   continuing brain chemistry alteration, or they may simply prevent the
   resolution of the difficulties which may have triggered the initial
   alteration, or both.

   The depressive brain chemistry alteration seems to be self-limiting
   in most cases: after one to three years, a more normal chemistry
   reappears, even without medical treatment. However, if the alteration
   is profound enough to cause suicidal impulses, a majority of
   untreated depressed people will in fact attempt suicide, and as many
   as 17% will eventually succeed. Therefore, depression must be thought
   of as a potentially fatal illness. Friends and relatives may be
   deceived by the casual way that profoundly depressed people speak of
   suicide or self-mutilation. They are not casual because they "don't
   really mean it"; they are casual because these things seem no worse
   than the mental pain they are already suffering. Any comment such as,
   "You'd be better off if I were gone," or "I wish I could just jump
   out a window," is the equivalent of a sudden high fever; the
   depressed person must be taken to a professional who can monitor
   their danger. A formulated plan, such as, "I'm going to jump in front
   of the next car that comes by," is the equivalent of sudden
   unconsciousness: an immediate medical emergency which may require
   hospitalization.

   Depression can shut down the survival instinct or temporarily
   suppress it. Therefore, depressed suicidal thinking is not the same
   as the suicidal thinking of normal people who have reached a crisis
   point in their lives. Depressive suicides give less warning, need
   less time to plan, and are willing to attempt more painful and
   immediate means, such as jumping out of a moving car. They may also
   fight the impulse to suicide by compromising on self-injury --
   cutting themselves with knives, for example, in an attempt to
   distract themselves from severe mental pain. Again, relatives and
   friends are likely to be astonished by how quickly such an impulse
   can appear and be acted upon.

..


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