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Bipolar Affective Disorder

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About 1 in 100 people in the US has bipolar affective disorder, also known as manic depression. in this disorder, episodes of elation and abnormally high activity levels tend to alternate with episodes of low mood and abnormally low energy levels (depression). More than half of all people with bipolar affective disorder have repeated episodes. trigger factor for manic and depressive episodes are not generally known, although they are sometimes brought on in response to a major life-event, such as a marital breakup or bereavement. Bipolar affective disorder usually develops in the early 20s and can run in families, but exactly how it is inherited is not known.

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Symptoms?
Symptoms of mania and depression tend to alternate, each episodes of symptoms lasting an unpredictable length of time. between periods of mania and depression, mood and behavior are usually normal. however, a panic phase may occasionally be followed immediately by depression. sometimes, either depression or mania predominates to the extent that there is little evidence of a pattern of changing moods. Occasionally, symptoms of mania and depression are present during the same period.

The symptoms may include:

· Elated, expansive, or sometimes irritable mood.
· Inflated self-esteem, which may lead to delusions of great wealth, accomplishment, creativity, and power.
· Increased energy levels and decreased need for sleep.
·Distraction and poor concentration.
· Loss of social inhibitions.
· Unrestrained sexual behavior.
· Spending excessive sums of money on luxuries and vacations.

Speech may be difficult to follow because the person tends to speak rapidly and change topic frequently. At times, he or she may be aggressive or violent and may neglect diet and personal hygiene.

During an episode of depression, the main symptoms include:

· Feeling generally low.
· Loss of interest and enjoyment.
· Diminished energy level.
· Reduced self-esteem.
· Loss of hope for the future.

While severely depressed, an affected person may not care whether he or she lives or dies. About 1 in 10 people with bipolar disorder eventually attempts suicide.

In more severe cases of bipolar disorder, delusions of power during manic episodes may be made worse by hallucinations. When manic, the person may hear voices that are not there praising his or her qualities. In his or her depressive phase, these imaginary voices may describe a person’s inadequacies and failures. in such cases, the disorder may resemble schizophrenia.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

What might be done?
During a manic phase, people usually lack insight into their condition and may not know that they are ill. Often a relative or friend observes erratic behavior in a person close to him or her and seeks professional advice. A diagnosis of bipolar affective disorder is based on the full range of the person’s symptoms, and treatment will depend on whether the person is in a manic or a depressive phase. For the depressive phase, antidepressants are prescribed, but their affects have to be monitored to ensure that they do not precipitate a manic phase. during the first days or weeks of a manic phase, symptoms may be controlled by antipsychotic drugs.

Some people may need to be admitted to the secure environment of a hospital for assessment and treatment during a manic phase or a severe depressive phase. They may feel creative and energetic when manic and may be reluctant to accept long-term medication because it makes them feel “flat”.

Most people make a good recovery from manic-depressive episodes, but recurrences are common. for this reason, initial treatments for depression and mania may be gradually replaced with lithium, a drug that has to be taken continuously to prevent relapse. If lithium is not fully effective, other types of drugs, including certain anticonvulsant drugs, may be given. In severe cases in which the drugs have no effect, electroconvulsive therapy may be used to relieve symptoms by including a brief seizure in the brain under general anesthesia.

Once symptoms are under control, the person will need regular follow-ups to check for signs of mood changes. A form of psychotherapy can help the person come to terms with the disorder and reduce stress factors in his or her life that may contribute to it.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies

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Anxiety Disorders

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Temporary feelings of nervousness or worry is stressful situations are natural and appropriate. however, when anxiety becomes a general, response to many ordinary situations and causes problems in coping with normal, everyday life, it is diagnosed as a disorder.

Anxiety disorders occur in a number of different forms. The most common is generalized anxiety disorder or persistent anxiety state, characterized by excessive and persistent anxiety that is difficult to control. Another type of anxiety disorder is panic disorder, in which there are recurrent panic attacks of intense anxiety and alarming physical symptoms. these attacks occur unpredictably and usually have no obvious cause. panic attacks may also feature in generalized anxiety disorder. In another type of anxiety disorder known as phobia, severe anxiety is provoked by an irrational fear of a situation, creature, or object.

Generalized anxiety disorder affects about 1 in 25 people in any one year in the us. The condition usually begins in middle age, and women are more commonly affected than men. sometimes anxiety disorders exist alongside other mental health disorders, such as depression or schizophrenia.

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What are the causes?
An increased susceptibility to anxiety disorder may be inherited or may be due to experiences in childhood. for example, poor bonding between a parent and child and abrupt separation of a child from a parent have been shown to play a part in some anxiety disorders. Generalized anxiety disorder may develop after a stressful life event, such as the death of a close relative. however, frequently the anxiety has no particular cause. Similarly, panic disorder often develops for no obvious reason.

What are the symptoms?
People with generalized anxiety disorder and panic disorder experience both psychological and physical symptoms. However, in generalized anxiety disorder, the psychological symptoms tend to be persistent while physical symptoms are intermittent. In panic, attacks, both psychological and physical symptoms come on together suddenly and unpredictably. The psychological symptoms of generalized anxiety disorder include:

· A sense of foreboding with no obvious reason or cause.
· Being on edge and unable to relax.
· Impaired concentration.
· Repetitive worrying thoughts.
· Disturbed sleep and sometimes nightmares.

In addition, you may have symptoms of depression, such as early waking, or a general sense of hopelessness. Physical symptoms of the disorder, which occur intermittently, include:

· Headache.
· Abdominal cramps, sometimes with diarrhea and vomiting.
· Frequent urination.
· Sweating, flushing and tremor.
· A feeling of something being stuck in the throat.

Psychological and physical symptoms of panic attacks include the following:

· Shortness of breath.
· Sweating, trembling and nausea.
· Palpitations.
· Dizziness and fainting.
· Fear of choking or that death may be imminent.
· A sense of unreality and fears about loss of sanity.

Many of these symptoms can be misinterpreted as signs of a serious physical illness, and this may increase your level of anxiety. Overtime, fear of having a panic attack in public may lead you to avoid situations such as eating out in restaurants or being in crowds.

What might be done?
You may be able to find your own ways of reducing anxiety levels, including relaxation exercises. if you are unable to deal with or identify a specific cause for your anxiety, you should consult your doctor. It is important to see a doctor as soon as possible after a first panic attack to prevent repeated attacks. There are several measures you can try to help control a panic attack, such as breathing into a bag. For any anxiety disorder, your doctor may suggest counseling to help you manage stress. You may also be offered cognitive therapy or behavior therapy to help you control anxiety. A self-help group may also be useful.

If you are coping with a particularly stressful period in your life or a difficult event, your doctor may prescribe a benzodiazepine, but these drugs are usually prescribed for only a short period of time because there is a danger of dependence. You may be prescribed beta-blocker drugs to treat the physical symptoms of anxiety. If you have symptoms of depression, you may be given antidepressant drugs, some of which are also useful in treating panic attacks.

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In most cases, the earlier that anxiety disorders are treated, the quicker their effects can be reduced. Without treatment, an anxiety disorder may develop into a life-long condition.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Resources:

http://www.charak.com/DiseasePage.asp?thx=1&id=24

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Alcohol Dependence

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A person who is dependent on alcohol has an irresistible compulsion to drink, which takes priority over almost everything else in life. This craving for drink coupled with withdrawal symptoms when drinking stops, is what separates alcohol dependence from alcohol abuse, a term used to describe regular drinking to excess. About 14 million people in the us abuse or are dependent on alcohol. drinking problems are most common in men, particularly between the ages of 20 and 40. In addition to causing damage to the liver and brain, the need to drink to excess regularly is damaging to mental health and may destroy a person’s family and social life and career.

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What are the causes?
Alcohol dependence is often the result of a combination of factors. sometimes alcohol dependence runs in families, partly as a result of children growing up in an environment of heavy drinking and partly because of an inherited predisposition. People who are shy, anxious, or depressed may rely heavily on alcohol. Working as a bartender or in an occupation that is associated with social drinking increases the risk of dependence. stressful life events may turn a moderate drinker into a heavy one.

What are the symptoms?
Alcohol dependence may develop after a number of years of moderate to heavy drinking.

symptoms may include:
· A compulsion to drink and loss of control over the amount consumed.
· Increased tolerance to the effects of alcohol, leading to greater consumption to achieve the desired effects.
· Withdrawal symptoms, such as nausea, sweating, and tremor, which starts a few hours after the last drink.

In severe cases, withdrawal seizures develop after alcohol is stopped. after a few days without alcohol, delirium tremens may develop with symptoms of liver, shakes, seizures, disorientation and hallucinations. Symptoms last for 3 to 4 days and are usually followed by a deep, prolonged sleep. in extreme cases, shock occurs and may be fatal.

Are there complications?
Alcohol has direct effects on the body and may cause many diseases. long-term alcohol dependence is the most common cause of severe liver disease and may damage the digestive system, causing peptic ulcers.

Heavy drinkers often have a poor diet, which may lead to a deficiency in vitamin b1 that may eventually cause dementia. rarely, sever thiamine, deficiency leads to wernicke-korsakoff syndrome, a severe brain disorder that causes confusion and amnesia and may lead to coma. If excessive drinking continues for a prolonged period of time, damage to vital organs may be life-threatening.

Psychiatric disorder associated with alcohol dependence include anxiety, depression and suicidal behavior. generally, a person with alcohol dependence becomes self-centered and lacks concerns for family and friends.

How is it diagnosed?
Before the doctor can make a diagnosis, a person may need to be persuaded to seek help. the doctor will ask about the extent of the person’s drinking and look for evidence of dependence. Blood tests to assess possible damage to the liver and other organs may be arranged.

What is the treatment?
Gradual reduction of alcohol intake or limiting alcohol consumption to social drinking is rarely possible. instead, the person will be asked to stop drinking completely. In mild to moderate cases, withdrawal can take place at home, provided that adequate support is available. antianxiety drugs, such as benzodiazepine, may be prescribed for a short time to reduce agitation and other physical effects of withdrawal.

When heavy drinking is stopped suddenly, withdrawal seizures or delirium tremens may develop. the symptoms of delirium tremens are potentially life-threatening and require admission to the hospital or a special detoxification unit. “withdrawal symptoms are usually treated with antianxiety drugs.

Treatment for physical problems as a result of long-term alcohol dependence includes ulcer-healing drugs for peptic ulcers and vitamin b1 injections for a thiamine deficiency.

When the symptoms of withdrawal have been treated, the doctor may prescribe drugs that reduce craving for alcohol or cause unpleasant reaction when it is consumed.Support is given to help prevent a relapse. Individual counseling or group therapy may help people address the problems that contribute to alcohol dependence.

What is the prognosis?
Accepting that there is a problem and receiving emotional support during the effort to give up drinking greatly improve a person’s chance of recovery. attending a self-help group, such as alcoholics anonymous, reduces the risk of relapse. however, after a long period of dependence, several attempts at detoxification may be needed before a person abstains from alcohol altogether.

In about 1 in 5 cases in which delirium tremens develop and is untreated, the condition proves fatal.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

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Anorexia Nervosa: A serious eating disorder

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..click & see is a developmental period fraught with the physical and psychological changes that accompany the transition from childhood to adulthood. Teenagers must cope with the establishment of independence from parents, the creation of personal identity, the development of intimate relationships with members of the opposite sex, and the bodily changes that herald adulthood. Often, the key to self esteem lies in feelings about physical attractiveness. In our society, the high premium placed on thinness can create anxiety during this metamorphosis. Considering the myriad of social, academic, and parental pressures adolescents must face, it s no wonder some adolescents develop physical and psychological disturbances….click & see

A common manifestation of such disturbances is the development of an eating disorder. The incidence of the three common eating disorders    anorexia nervosa, bulimia, and obesity have increased in the last decade. Among women aged 15 to 30, incidence rates are roughly 30 percent for obesity, 10 percent for bulimia, and one percent for anorexia nervosa. Although the least common of these three eating disorders, anorexia nervosa carries the gravest medical and psychological consequences.

Anorexia nervosa is a serious condition wherein a person systematically restricts food intake to the point of extreme emaciation. In 1689, a physician first described a patient with this illness as “a skeleton wrapped up in skin.” Anorexia nervosa is also characterized by an irrational fear of becoming obese, denial of physical discomfort, excessive physical activity, and high self expectations. Although “anorexia” means lack of appetite, people with anorexia nervosa may actually be concealing a large appetite. In fact, they are morbidity preoccupied with food and fear losing control and falling victim to binge eating.

Alarmingly, the incidence of anorexia nervosa has doubled over the past two decades. Most anorectics are white and come from middle class or upper middle class families. Some 90 to 95 percent of those with anorexia nervosa are female.

Anorexia nervosa usually begins in adolescence. A typical case is a mildly overweight teenager who believes herself to be overweight. She reduces her weight by 5 to 10 pounds. Rather than stopping there, she finds it becomes easier and easier to lose weight. Whether this continued weight loss stems from a boost to her self esteem or from physiologic changes secondary to starvation is unclear. The weight loss is maintained by severe restriction of caloric intake or food restriction alternating with periods of binge eating that end in self-induced vomiting or purging with laxatives and diuretics (“water pills”).

Regardless of the method of attaining the weight loss, the danger is that further emaciation may progress unremittingly until death. The overall mortality rate has been reported to be between two and 15 percent. One reason the patient allows herself to pursue this macabre wasting course is attributed to a “body image disturbance.” Specifically, patients with anorexia nervosa deny they are too thin or that they experience any physical discomfort from their self-imposed starvation. In fact, they may insist they are still slightly overweight even when severely emaciated. Surprisingly, the parents may also deny the existence of a problem. Therefore, teenagers with anorexia nervosa often come to medical attention in a severe state of inanition. The physical and psychological consequences can be severe.

Of the psychological consequences, the most feared is suicide. Although the incidence of suicide among anorectics is relatively low (two to five percent), it is high compared to the general population. Other psychological problems, such as depression, obsessive-compulsive behavior, and difficult family relationships may persist even after weight gain.

The most common physical manifestations of anorexia nervosa in women are amenorrhea (absence of menstruation) and estrogen deficiency. The latter may contribute to osteoporosis (brittle bones). A host of other hormonal disturbances often accompany anorexia nervosa. Imbalance in body chemistry can also have dire consequences. For example, starvation, vomiting. laxative, and diuretic abuse can all cause dangerous lowered levels of potassium in the blood. Low potassium can cause disturbances in the heart s rhythm and even cardiac arrest, the leading cause of death in anorexia nervosa. Additionally, many anorectics also have abnormally slow heart rates and low blood pressure.

Disorders of the gastrointestinal tract, such as constipation, are common. Anorexia nervosa also predisposes patients to kidney stones. Because malnourishment impairs the immune system, patients are at an increased risk for infection.

In short, the consequences of anorexia nervosa are diverse and many are serious. But, what causes anorexia nervosa? No one knows for sure. This disease can vary along a broad spectrum of severity ar-id may have just as broad a spectrum of contributing causes. Theories incorporate sociocultural factors, occupational and recreational environments. psychological causes, and neurochemical abnormalities.

Western society may play an important role because of the emphasis placed on thinness, especially for women. In a society where one is held personally responsible for one s body type (“you are what you eat”), obesity is tantamount to failure. Other societal pressure such changes in the ecology of food and eating (eg. high calorie fast foods), alterations in family and community life, and nuclear threat have also been implicated as contributing to rising rates of anorexia nervosa.

Occupational and recreational environments that put women at risk for anorexia nervosa are those that stress thinness such as ballet and athletics. Both the strenuous physical training and the restricted calorie intake contribute to the development of the disease.

Anorexia nervosa used to be viewed as primarily a psychological disorder. Now, the many physical complications are given equal attention. However, normal psychological functioning is often impaired. Patterns of early developmental problems and disturbed family interactions, accompanied by depression are often noted. Patients often experience a paralyzing feeling of ineffectiveness. Weight loss may be a defense against such feelings, a way to gain control over one s self.

Current research is focusing on a search for abnormalities in the hormones and chemicals that transmit nervous impulses in the brain. Whether these disturbances are the underlying cause of anorexia nervosa or are a result of starvation remains to be seen.

While the definitive cause of anorexia nervosa is unknown, treatment will probably continue to be largely unsatisfactory. Denial of the illness by the teenager and family alike impede compliance with treatment.

Current treatments include nutritional rehabilitation, individual, group, and family psychotherapy, and occasionally, antidepressants. In severe cases, the teen is hospitalized to correct physical imbalances or to prevent possible suicide. Unfortunately, relapses are common.

Anorexia nervosa is a serious illness with grave consequences. It is disturbing to health care professionals that the incidence is rapidly rising. Hopefully, in the future, the exact cause of anorexia nervosa will be discovered allowing for better treatment.

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Anorexia and Pregnancy
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Facts About Depression

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Learn the facts about depression, and what you can do to treat it.
In any given one-year period, 9.5% of the population, or about 18.8 million American adults, suffer from a depressive illness. The economic cost for this disorder is high, but the cost in human suffering cannot be estimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of this suffering is unnecessary.

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Most people with a depressive illness do not seek treatment, although the great majority — even those whose depression is extremely severe — can be helped. Thanks to years of fruitful research, there are now medications and psychosocial therapies such as cognitive/behavioral, “talk,” or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else’s life.

What’s a Depressive Disorder?
A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as 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 most people who suffer from depression.

Types of Depression:
Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Brief descriptions of the most commmon types of depressive disorders are given below. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual.

When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression and Mania:
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

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 were once enjoyed, including sex
Decreased energy, fatigue, being “slowed down”
Difficulty concentrating, remembering, making decisions
Insomnia, early morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain .
Mania :
Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior
Causes of Depression
Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently, additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

Evaluation and Treatment:
The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist.

A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.

Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems, including 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.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

From: The National Institute of Mental Health

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