Murat Engin AkkayaProfessor L. Adams English 11222 April 2005 Depression " Mom is sad all the time. She cries a lot. Sometimes she doesn't get up in the morning. She stays in bed until late in the afternoon with covers pulled up around her ears. At first I didn't worry.

She'd stay in bed for a day or two and then get up again, and I'd think she was better. But after a couple of weeks, she didn't eat much any more, and she stayed in her room most of the time.".. "She has something called depression" (Den Boer, Helen 1-2). Most people today do not think that depression is an illness. In fact most people think that depression is a moral failure.

"Some 400, 000 patients are treated for depression in the United States annually, most as outpatients and most by non-psychiatric physicians" (Hollister, Leo E 80). In 1989, major depression cost the nation at least $27 billion in medical care, worker absenteeism, and related costs. In 2002, "as many as 14 million people in the United States had symptoms of depression, resulting in a prevalence rate of 3% to 7% of the general population. This led to a loss of approximately $40 billion dollars a year in productivity (Breen, Robert and McCormac, Rupert 1). Everyone at one time or another has felt depressed, sad, or blue.

Being depressed is a normal reaction to loss, life's struggles, or an injured self-esteem. But sometimes the feeling of sadness becomes intense, lasting for long periods of time and preventing a person from leading a normal life. In fact depression is often considered a 'female disease,' since affected women reportedly outnumber men by four to one. Yet male depression may be more.

"Many men try to hide their condition, thinking it unmanly to act moody. And it works: National studies suggest that doctors miss the diagnosis in men a full 70% of the time" (Real, Terrance 1). But male depression also stays hidden because men tend to express depression differently than women do. Depressed women are more likely to talk abut their problems and reach out for help, while depressed men will often turn to some action or substance for relief.

Men often attempt to escape pain by overusing alcohol or drugs, working excessively or seeking extramarital affairs. They go into isolation, withdrawing from loved ones, and they may lash out, becoming irritable or violent (Real, Terrance 1). The American National Institute of National health has defined depression as an illness that involves the body. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. 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 (National Institute of Mental Health). According to the same report nearly 18. 8 million Americans over the age of 18 suffer from major depression. Suicide, closely linked to depression, is the third leading cause of death in 10- to 24-year-olds.

Unfortunately, most people never seek treatment. "Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly even result in suicide" (National Institute of Mental Health). Depression is far more common than most people realize. "Two out of every 10 people are clinically depressed.

Approximately 23 percent of all adult women have had one major depressive episode in their lifetime. Depression has touched the lives of some of the most successful and brilliant men and women of our time. Sylvia Plath, Dick Caveat, Georgia O'Keeffe, Mark Twain, Virginia Woolf, and Abraham Lincoln all wrestled with depression" ( (Myrna A. Wallis 1). Douglas Jacobs, a Harvard Medical School psychiatrist who has devised national screening programs for depression, says that the key difference between having sad feelings and a true major depression is that sad feelings eventually pass. Depression comes in many forms.

Some of the most common types of depression are; major depression, dysthymia and bipolar disorder. Major depression has steadily increased in all age groups over the past few decades. It is now the most common chronic condition seen by primary care physicians and is present in five to nine percent of patients. (National Institute of Mental Health). Major depressions has symptoms such as sad mood, low energy, loss of interest in usual activities, difficulty concentrating, changes in eating or sleeping habits, and suicidal thoughts. It affects people of all ages, striking women twice as often as men.

In 1989, major depression costed the nation at least $27 billion in medical care, worker absenteeism, and related costs (National Institute of Mental Health). As for dysthymia it refers to mild to moderate depression and those with it live in a gray state that may be the only condition they have known. To be diagnosed with dysthymia, one has to have had persistent symptoms for at least 2 years. In many cases, patients have lived with dysthymia so long that they have come to accept it as part of their personality. Also, with the right treatment, they may begin to feel better than they ever have. Symptoms of dysthymia are the same as those of major depression and include: "difficulty sleeping, loss of interest or the ability to enjoy oneself, excessive feelings of guilt or worthlessness, loss of energy or fatigue, difficulty concentrating thinking or making decisions, and Changes in appetite (Michalak, Erin E; Lam, Raymond W 1).

Bipolar disorder (manic-depressive disease), major depressive episodes alternate with periods of extreme elation or agitation, known as mania. The manic phase can develop gradually and is preceded by a state called hypo-mania. Erin Michalak and Lam Raymond also state that "Being hypo manic can be extremely seductive because it confers extra verve, productivity, and sociability. Hypo manic's are often the lives of the party and may have charismatic appeal for others" (1). Symptoms of mania can be divided into two - the high and low phase symptoms. Symptoms for the high include: "excessive happiness, hopefulness, and excitement, sudden changes from being joyful to being irritable, angry, and hostile, restlessness, rapid speech and poor concentration, increased energy and less need for sleep, high sex drive, tendency to make grand and unattainable plans and drug and alcohol abuse (Michalak and Raymond 1).

Symptoms of the low phase of Bipolar depression are the same as those of major depression and include: sadness, loss of energy, feelings of hopelessness or worthlessness, loss of enjoyment from things that were once pleasurable, difficulty concentrating, uncontrollable crying, difficulty making decisions, irritability, increased need for sleep and insomnia or excessive sleep (Michalak and Raymond). Depression is a treatable illness that has many-many causes. Trying to discover the exact causes of depression is a difficult task that doctors have faced for decades. Since depression can be caused by numerous factors, this is one of the reasons it is considered a complex disease. For some depression occurs due to loss of a loved one, a change in one's life, or after being diagnosed with a serious medical condition.

Other causes include the following, but are not limited to just this. They include; a history of depression in the family: It is believed that depression is passed genetically from generation to generation, although the exact way this occurs is not known, grief from the death or loss of a loved one, personal disputes, conflict with a family member, physical, sexual or emotional abuse, major events that occur in everyone's lives, such as moving, graduating, changing jobs, getting married or divorced, retiring, and substance abuse: close to 30% of people with substance abuse problems also have major depression. (Terrance 1) It is also important to note that some medicines can cause depression. Some of these medicines are Anticholinergic's -- A group of medicines used to relieve cramps or spasms of the stomach, intestines, and bladder. Examples include Ana spaz, Bentyl, Gastro sed, Lev bid, and S ymax, Cogent in -- A medicine used to treat the symptoms of Parkinson's disease, Corticosteroid and Cyclosporine -- A drug used to suppress the immune system to prevent the rejection of transplanted organs (Terrance 1). Another cause of depression can be related to chronic or life long illnesses.

However, chronic illnesses can often be controlled through diet, exercise, and certain medicines. People diagnosed with chronic illnesses must adjust to the demands of the illness itself, as well as to the treatments for their condition. The illness change the way a person lives, sees him or herself, and / or relates to others. As a result in some cases the illness will be a major factor in the cause for depression. Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression.

Depression and illness may occur together because the physical changes associated with the illness trigger the depression, the individual has a psychological reaction to the hardships posed by the illness, or simply as a coincidence. Accurate diagnosis is most important step in managing depression. Diagnosing depression is a complex process as information must be gathered from a variety of sources and then analyzed by a health professional experienced in diagnosing and treating depression. Although some pediatricians and family doctors are knowledgeable on the subject, mental health professionals such as psychiatrists and psychologists are the ones who have special training in depression (Myrna A. Wallis 1). In Helen Den Boer's book, "Please don't cry.

Mom", when the mother went to see a doctor due to depression she saw a psychiatrists. Because the process of diagnosing is so complex, more than one health professional may have to take part in the evaluation process. The process should include a physical examination, patient history, psychological testing, and an interview with the patient as well as with his or her parents, guardian or spouse. Because depression tends to affect so many aspects of a person's life, the mental health professional who is making the diagnosis must find out about how the person is functioning in all areas of his or her life (Myrna 1).

In the last 25 years, treatment of major depression has really changed and gone through a dramatic transformation in the most recent 10 years. Research indicates that although all of the modern antidepressant drugs are relatively safe and effective, choosing a treatment can be a daunting task. The decision should be based on an assessment of each patient individually and consideration of which drug the patient is likely to tolerate well over the long term. Promoting adherence to treatment involves controlling factors such as cost and side effects. There is also an indication that there are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Antidepressants do however benefit most people with mild forms of depression.

Antidepressants however do not work alone. For most people taking the medication to gain relatively quick symptom relief and seeing a doctor to learn more effective ways to deal with life's problems will probably manage and heal from their depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and / or one of the several forms of psychotherapy that have proven effective for depression (Breen and McCormac). Myrna A. Wallis, a former Instructor of Psychiatric nursing claims that almost 80% of people with serious depression are successfully treated and recover their vitality" (1). So what happens to a family that experiences depression? Den Boer's book describes situation where the dad and the son each blame themselves for mum's depression.

.".. Maybe if I got better grades on my report card or didn't make so much noise around the house, she'd feel better. Dad told me sometimes he feels like it's his fault too. But it's really nobody's fault he said. "it's a sickness. Not even the doctors know what causes it." (12).

It is important for family members to realize that they are not responsible for a loved one's depression. Couples normal take care of each other, so when a mother or a father is ill, the couple is no longer the same. "They can't nurture each other the way they used to. Your father now plays a role of being both the father and the mother. A prime example of this kind of situation is in Den Boer's book. The father plays the role of both dad, and mum, in taking care of the son.

He prepares everything for his son, since mum is always asleep or "resting" on the couch. Involving family members during the healing time is very important. This is because the person diagnosed with depression will need family support at this time. Plus if the person is severely depressed, the patient might not be able to respond to questions or make decisions. The family members can therefore answer most of the questions and make the right decisions concerning the treatment.

Also by involving the family, this allows for a chance to gather more information as to the causes of depression and also a chance to teach them about the condition, its treatment, and the warning signs of suicide. From Den Boer's book, by involving the family - the grandmother and the son, the dad was able to help his wife in the recovery process. This was also very helpful for his son - Stephen - as he could now understand what depression was and what some of the causes of the condition would be. Although treatment of depression will really help the patient, it does also come with negative side effects. These side effects not only occur in the body, but also on the wallet. In a study on depression in 2002, it was estimated that for patients with no drug insurance coverage, the current cost of ant depressive therapy with the aforementioned drugs, run from $60 t o$80 per month.

The cost could exceed $100 a month if therapy treatments were also needed. Other side effects included drugs that made the patients sleepy, weight loss or gain, diarrhea, and sexual side effects, dry mouth, bladder problems, dizziness and blurred vision. Suicides are the most serious consequences of untreated depression. Older persons with suicidal depression are five more times to kill themselves than younger persons. Estimates of successful suicides in the United States vary from 26, 000 known to 75, 000 possible; many suicides are not reported" (Hollister 80). Suicide often isn't listed as the cause of death, even if it suspected as it doesn't reflect the number of people who commit suicide by not eating, by abusing alcohol and medications, or by simply losing the will to live.

Because of the low energy levels and impeded thought process that accompany severe depression, a patient may be unable to act on their suicidal thoughts at first. Close monitoring in such cases is very important. Depression in all its forms affects a lot of people around the world. It is an illness that has gone untreated and unrecognized for a long time. Depression affects the lives of the people affected and puts a burden on the community and family members.

It is important for everyone to recognize that depression is an illness that requires treatment and assistance. It is perhaps the most common medical condition seen by primary care physicians today, and rapidly evolving drug therapy present management challenges. However at least newer medications are good, helpful and carry fewer risks with small side effects. Accurate diagnosis still remains the main focus point for effective patient care.