PAIN RELATED DEPRESSION

Depression is more than the "blues" that affects so many people. Depression, in the largest part, is a disease that results from a biochemical imbalance in the brain, and is a true medical condition. Depression is not a "weakness," and it has been demonstrated repeatedly that the patient who suffers from depression may have increased mortality due to other conditions, such as atherosclerotic heart disease, heart attack, cancer, as well as from suicide.

There are many different medical types of depression. For example, one type of depression that occurs during the holiday season often results from a common condition, called "Seasonal Affective Disorder," or S.A.D. This condition affects many millions of Americans, and results in tremendous loss of productivity.

Depression results from a chemical imbalance in the brain that results from a decrease in the presence of certain neurotransmitters, such as "seratonin" and "norepinephrine." If certain nerve endings in the brain fail to secrete enough of these neurotransmitters, depression can result. Interestingly, there are many different types of depression, each with its' own set of symptoms. Early insomnia, or inability to get to sleep, middle insomnia, or inability to stay asleep, may be manifestations of two entirely different neurotransmitters. Proper treatment requires the use of the medication that restores the right neurotransmitter. The responsibility to relate ACCURATELY the symptoms of depression, such as insomnia, will increase the liklihood that your physician will choose the medication right for the individual situation.

Interestingly, depression can be present IN THE ABSENCE OF AN OVERT MOOD COMPLANT!

Of the many types of depressive illnesses, they may demonstrate patterns of exacerbation and remission. If the presenting symptom is periodic depression alone, this is referred to as a "Unipolar" pattern. If depression alternates with periods of elation or mania, this is referred to as a "Bipolar" pattern, "Cyclothymia" referrs to periodic ups and downs not severe enough to be considered "mania" or "depression."

TYPICAL PRESENTATION OF DEPRESSION

The average age of onset is in the mid-20's. Criteria for diagnosis include:
Depressed mood
Loss of energy or motivation
Weight loss or gain
Alteration in sleep patterns: too much, too little, poor quality sleep
Agitation or physical slowing
Inability to concentrate
Suicidal thoughts
Not all symptoms need to be present to consider the diagnosis of depression.

REACTIVE DEPRESSION

Depression is one type of depression that tends to occur after a traumatic event, after the loss of limb, serious illness, or loss of a person or object very meaningful to the individual. After the normal grief period, most people recover and move on with their lives. Some, however, suffer for prolonged periods of time, either eventually recovering, or experiencing worsening of the depressive symptoms. One example of a type of reactive depression is "Post Traumatic Stress Disorder," or PTSD. PTSD can occur in otherwise strong and well adjusted individuals. PTSD is often associated with war time experiences, but it more commonly occurs following civilian accidents, or troubling life's events.

Symptoms of reactive depression may include: Loss of energy, weakness, spells of crying, excessive drinking or substance abuse, bouts of rage, sleep and eating disorders.

Alcoholism and drug abuse is quite common in the person who suffers from reactive depression.

Treatment can only take place after recognition. Diagnosis is most commonly established by the family physician, but not all family physicians are equally skillful in recognition and treatment of psychiatric disorders.

Medications most commonly used to treat reactive depression include: Tricyclic anti-depressants (e.g. amitryptaline, Elavil) anti-depressants of the selective seratonin reuptake inhibitor (SSRI) class (e.g. Prozac, Zoloft) or selective seratonin norepinephrine re-uptake inhibitor (SNRI) class (e.g. Effexor, Serzone). All are very useful to treat depression.

If, among the complaints is that of insomnia, Paxil is a good first choice. If lethargy, sleepiness and inability to "motivate" is a presenting problem, Zoloft may be a better choice. If fibromyalgia is present, Serzone or Effexor may be better. Eating disorders, weight gain and increased alcohol consumption are commonly associated with reactive depression. Diagnosis can be made only if the diagnosis is kept in mind.