DEPRESSION  [ back to Glossary Index ]
Depression is a disorder of mood manifested by such hallmarks as persistent sadness, apathy, feelings of emptiness or worthlessness, inability to feel pleasure, hopelessness, restlessness, worry, anxiety, frustration or irritability. These feelings are typically accompanied by disturbances in normal patterns of eating, sleeping, socializing. There is often social withdrawal, loss of libido, lethargy, excessive crying and possibly thoughts of death or suicide. There are 17,000,000 people in the Unites States living with depression. Only about one-third of them seek treatment. Modern thinking finds depression to arise from a combination of genetics, temperament and environmental triggers such as a sudden, unwelcome event like divorce, a death in the family, loss of a job or a traumatic injury. Psychiatrists classify depression as: classic bi-polar manic-depression (with frequent, dramatic and wild mood swings); cyclothymia (a low grade chronic form of bi-polar); major depression (the severe form of unipolar depression which can warrant hospitalization); and dysthymia (chronic, low-level, smoldering type of depression). Double depression is a major depression superimposed upon a pre-existing dysthymia.

Lithium and anti-convulsants are used to treat bi-polar. Anti-depressants like Prozac or Zoloft, alone or in conjunction with psychotherapy, are used to treat mild unipolar depression.  About one million people in the U.S. suffer from intractible depression, and of these about 15% will commit suicide. Electroshock treatments are still used with such patients, but even with milder currents and less frequent administration, ECT still causes memory loss. A new, experimental treatment is vagus nerve stimulation from a pace-maker like device implanted in the patient's chest. A gentle current is sent out for 5 minutes at a time, 24 hours a day. When stimulated in this manner, the vagus nerve modulates the limbic area of the brain and lifts or improves the depressed mood in some patients.

Although depression is a true disorder of mood with "vegetative symptoms" like insomnia and anorexia, it can breed "learned helplessness" in the face of life's challenges, which will outlast resolution of vegetative symptoms through medication. Hence, psychotherapy and behavioral therapy are also important s of the treatment. Depression is a common feature of post-concussion syndrome and traumatic brain injury, arising from such diverse causes as left hemisphere damage and emotional reaction to pain, disability, loss of skills and loss of friends. The limbic area in the brain, where depressed mood gets its foothold, is directly wired in complex ways with the frontal lobes where we think, plan and organize. In the brain you cannot separate depression from thinking. As one sage put it "you cannot balance your checkbook when you're depressed." PET scans show the thinking part of the brain is inactive (hypometabolic) when the "depression circuits" light up in the anterior cingulate, amygdala and thalamus.

Depression is a stress response gone awry, which induces chronic high output of stress hormones like cortisol. This in turn increases the "stickiness" of the platelets (clotting factors) in the blood, which leads to higher incidence of heart attack and stroke in depressed patients. A stroke is fatal 66.66% more of the time in a depressed patient than a non-depressed one. Congestive heart failure is 4 times more likely to cause death in a depressed patient than a non-depressed one. When depression lifts due to anti-depressant therapy or psychotherapy the blood platelets become less sticky and blood flow changes are evident in the brain on PET or fMRI. Some 30-40% of major depression in the elderly is associated with "silent stroke," from a vascular lesion which shuts off blood flow to the basal ganglia. Such strokes are called silent because they do not announce themselves by slurred speech, stumbling, falling or loss of consciousness. Instead they manifest themselves through intense sadness, crying, apathy and difficulty concentrating. When brain trauma is severe enough, as in a fall from a high place onto one's head or a very high speed auto crash, the basal ganglia can be damaged.