Gut microbes important for serotonin production

Serotonin is probably best known as a brain chemical that affects emotions and behavior, an imbalance of which is thought to contribute to depression. Less well-known is that scientists estimate 90% of serotonin is made in the gut, and imbalances in this peripheral serotonin have been linked to diseases ranging from irritable bowel syndrome and cardiovascular disease, to osteoporosis.

90% of serotonin is made in the gut.
Image credit: E. Hsiao/Caltech

Now, researchers from the California Institute of Technology (Caltech) in Pasadena report a study in the journal Cell that shows certain bacteria in the gut play an important role in the production of peripheral serotonin.

Senior author Elaine Hsiao, research assistant professor of biology and biological engineering at Caltech, says studies of mice and other lab animals are increasingly showing that changes in gut microbes affect behavior.

She explains that she and her colleagues were interested in finding out more about how gut microbes and the nervous system talk to each other, and:

"To start, we explored the idea that normal gut microbes could influence levels of neurotransmitters in their hosts."

In the gut, there are three types of cell we know of that produce serotonin: immune cells, nerve cells or neurons, and enterochromaffin (EC) cells.

Gut microbes appear to influence serotonin production by EC cells

For their study, Prof. Hsiao and colleagues wanted to find out which cells the gut microbes might be influencing to have an effect on serotonin levels.

In the first part of the study, they compared peripheral serotonin levels produced from these cells in two groups of mice: one with normal gut microbes and another group of germ-free mice without gut bacteria.

The team found that in the germ-free mice, their EC cells produced around 60% less serotonin than the mice with normal gut bacteria.

And when they restored bacteria colonies in the gut of the germ-free mice, their EC cells began producing normal levels of serotonin - showing the effect on the EC cells can be reversed.

In the next part of the study the team set out to find which bacteria in particular were interacting with the EC cells to make serotonin.

They introduced single species and groups of gut microbes one by one into the germ-free mice, and found that serotonin levels went up when there was a certain mix of about 20 species of spore-forming bacteria.

Introducing this particular bacterial mix into the germ-free mice increased the movement of food through their digestive tract. It also changed activity in their blood platelets, which use serotonin to boost clotting.

Bacteria control gut microbiota metabolites to influence serotonin production

Further exploration in cell cultures revealed some of the molecular mechanisms underpinning the findings. The team found several metabolic byproducts of gut bacteria are controlled by the mix of spore-forming bacteria and act on EC cells to alter serotonin production.

When the researchers increased these metabolic byproducts in germ-free mice, it increased their levels of peripheral serotonin.

Other investigations have shown bacteria can make serotonin on their own. The researchers say their study suggests a lot of the serotonin in the body relies on the interaction between bacteria and host cells.

Prof. Hsiao says a lot more research needs to be done before findings like theirs are ready for clinical use, and offers a word of caution:

"We identified a group of bacteria that, aside from increasing serotonin, likely has other effects yet to be explored. Also, there are conditions where an excess of peripheral serotonin appears to be detrimental."

She and her team now plan to find out how their findings may apply to the human brain.

Researchers are also discovering other surprising things about serotonin in the body. For example, Medical News Today recently learned how a previously unknown source of serotonin could affect antidepressant activity.

One of the main drawbacks of SSRIs (selective serotonin reuptake inhibitors - a class of antidepressants that prevent reuptake of serotonin by increasing levels of it outside cells) is that they take a while to kick in. A study led by the University of Florence found that the source of this extracellular serotonin is not what experts have assumed, and finding out more about it should help improve drugs that target serotonin.

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9 in 10 people with mental illness report high levels of discrimination

They may have the sun, sea, Hollywood and Disneyland, but in a new study Californians report encountering high levels of discrimination due to psychological stress.

Most respondents felt that recovery from mental illness is possible - more than 70% said they are satisfied with life - and that they would seek treatment for mental illness when needed.

Behavioral scientists at the nonprofit research organization RAND worked with the California Mental Health Services Administration (CalMHSA) to conduct the California Well-Being Survey as an attempt to research and create prevention and early intervention programs to improve the mental health of Californians.

"This new report from RAND researchers highlights both the need to confront stigma, and the opportunity to promote mental health in our state with the statewide stigma reduction efforts offered by CalMHSA," says Wayne Clark, executive director of CalMHSA.

The researchers surveyed 1,066 Californians who had previously reported mild to serious psychological distress in the California Health Interview Survey, which looked at a variety of health issues.

The authors say that the new California Well-Being Survey is the first population-based survey to look at people who are either currently experiencing mental health problems - or are at risk from them - but who may not have received treatment.

Majority of respondents believe the mentally ill face high levels of prejudice

The behavioral scientists found that just 41% of respondents believed that people are caring and sympathetic toward people with mental illnesses, while a huge 81% believed that those with mental illnesses experience high levels of prejudice and discrimination.

More than two thirds of respondents stated that they would definitely or probably hide a mental health problem they were experiencing from co-workers or classmates. More than one third also said they would disguise mental health problems from family and friends.

Nearly 9 in 10 of those who reported having had a mental health problem said they experienced discrimination as a result of it - most often in intimate social relationships, but also in high levels at school or work. Health care providers and law enforcement officials were also alleged to behave in a discriminatory way by the study respondents.

However, despite reporting high levels of discrimination, more than 80% of participants in the survey said they have plans in place for them to stay or become well and continue to meet personal goals.

Overall, most participants felt that recovery from mental illness is possible - more than 70% said they are satisfied with life - and that they would seek treatment for mental illness when it is needed.

One third of people in the survey said that during the previous 12 months they had been reached by CalMHSA's early intervention efforts, and 90% reported engaging with other activities related to CalMHSA campaigns during the past year.

"This survey shows that CalMHSA's partnership of California's counties is successfully reaching the population most at risk for mental health challenges to increase support and encourage help-seeking," Clark says.

RAND's Eunice Wong, lead author of the report, says that although Californians facing a mental health challenge are displaying resilience in their own attitudes to mental health, stigma remains:

"While California residents facing mental health challenges are finding ways to cope and maintain important aspects of well-being, they are substantially burdened by self-stigma and discrimination, which may significantly undermine recovery. Our overall findings show a clear need for stigma and discrimination reduction efforts in California."

The study is part of RAND's evaluation of mental health initiatives funded by California's Proposition 63 - a tax on millionaires residing in The Golden State - that are designed to reduce stigma and discrimination around mental illness and prevent suicides.

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Mindfulness and antidepressants offer 'similar level of protection' against depression

Mindfulness-based cognitive therapy offers a similar level of protection against relapses of depression to antidepressants, according to the results of a new trial published in The Lancet.

Mindfulness-based cognitive therapy works by teaching people the skills to identify and respond constructively to thoughts and feelings linked with depression.

"Depression is a recurrent disorder. Without ongoing treatment, as many as 4 out of 5 people with depression relapse at some point," says lead author Willem Kuyken, professor of clinical psychology at the University of Oxford in the UK.

Antidepressants are currently the key maintenance treatment for preventing relapse - studies report that antidepressants reduce the likelihood of relapse by up to two thirds when taken correctly.

"However," says study co-author Prof. Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry in the UK, "there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side effects."

Mindfulness-based cognitive therapy (MBCT) works by teaching people who have experienced depression the skills to identify thoughts and feelings linked with depression when they encounter them. By responding constructively to these depressive thoughts, a full relapse may be avoided.

The UK-based researchers recruited 424 adults for their study who had recurrent major depression and were taking antidepressants. The participants were randomly assigned to either stay on their medication or to slowly come off their antidepressants and receive MBCT.

The 212 participants in the MBCT group attended eight group sessions that lasted for 2.5 hours each, which also involved daily homework exercises. These participants were also given the option of attending four follow-up sessions over a year-long period.

Similar outcomes reported for both groups over 2-year follow-up

The Structured Clinical Interview for DSM-IV psychiatric diagnostic interview tool was used to assess all trial participants at regular intervals over a follow-up period of 2 years.

The researchers found that 44% of the MBCT group participants and 47% of the participants on antidepressant medication relapsed over the 2-year follow-up period.

Five adverse events - including two deaths - were reported across both groups but were not considered to be related to either the interventions or the study.

Prof. Kyuken says of the study's results:

"Whilst this study doesn't show that mindfulness-based cognitive therapy works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, we believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions."

The authors report that theirs is the largest trial of any mindfulness-based approach to date, and that the study's validity was demonstrated through high rates of treatment adherence among both intervention groups and a relatively long follow-up.

One limitation of the study was that the recruitment strategy consisted of inviting patients who were already taking maintenance antidepressants rather than recruiting patients who were discussing their options for preventing relapse with their doctor.

In a linked comment, Prof. Roger Mulder, from the University of Otago in New Zealand, writes that as MBCT is a group treatment it may also reduce treatment costs and the number of trained staff needed:

"We therefore have a promising new treatment that is reasonably cost effective and applicable to the large group of patients with recurrent depression."

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Will losing weight really make you happier?

Although physical health is significantly improved by weight loss, the effects of losing weight on mental health are less clear, according to a new study by University College London researchers in the UK.

"People should not expect weight loss to instantly improve all aspects of life," say the researchers.

The study, which is published in the journal PLOS ONE, looked at 1,979 overweight and obese people in the UK.

It found that people who lost 5% or more of their original weight over 4 years showed significantly improved physical health. However, these people were more likely to report low mood than participants who stayed within their initial weight.

In the study, 14% of the participants lost at least 5% of their body weight - the mean weight loss was 6.8 kg per person.

Adjusting their results to take into account serious health issues and major life events that might cause weight loss and depressed mood, the researchers calculated that the participants who lost weight were 52% more likely to report symptoms of depression.

Lead author Dr. Sarah Jackson, of University College London's Epidemiology and Public Health department, says:

"We do not want to discourage anyone from trying to lose weight, which has tremendous physical benefits, but people should not expect weight loss to instantly improve all aspects of life."

She adds that "aspirational advertising by diet brands" may set unrealistic expectations about weight loss by offering what appear to be instant life improvements. Dr. Jackson advises that people should be realistic about weight loss and be prepared for the challenges:

"Resisting the ever-present temptations of unhealthy food in modern society takes a mental toll, as it requires considerable willpower and may involve missing out on some enjoyable activities. Anyone who has ever been on a diet would understand how this could affect well-being.

However, mood may improve once target weight is reached, and the focus is on weight maintenance. Our data only covered a 4-year period so it would be interesting to see how mood changes once people settle into their lower weight."

She also says that health care professionals should monitor both the physical and mental health of patients when recommending weight loss and offer ongoing support as needed.

What were the study's limitations?

Although the researchers attempted to factor in major life events that could confound results, such as bereavement, which is known to be associated with both weight loss and depression, they acknowledge that data on this was limited.

The bereavement data only covered parents and spouses during the study, and did not take into account deaths of children, close friends or non-marital partners, or the deaths of parents or spouses shortly before the study commenced.

Another major life event that the study did not have data for that could have caused weight loss and depression was job loss.

The study participants were predominantly white, older adults. It is possible, therefore, that the effects of weight loss might be different among different ethnic groups or younger adults.

Also, the researchers admit problems with the measure of well-being used in the study, explaining:

"The use of an arbitrary, unvalidated threshold to indicate low levels of well-being is also problematic, and we observed some differences in results when well-being data were analyzed continuously, so these results should be interpreted with caution."

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Antidepressants linked to higher risk of type 2 diabetes

A new systematic review of published studies suggests when prescribing antidepressant medication, clinicians should be extra aware that they are linked to raised risk for type 2 diabetes, although the study does not suggest the drugs are the direct cause.
Reporting their findings in the latest issue of Diabetes Care, researchers from the University of Southampton say use of antidepressants has risen sharply over recent years, and there are concerns they may have an adverse effect on glucose metabolism.
They note 46.7 million prescriptions for antidepressants were issued in 2011 in the UK.
Antidepressant use has also soared in the US, where a 2011 study found they are now the third most widely prescribed group of drugs.
Several studies have shown that antidepressant use is linked to diabetes, but the results have been varied, depending on the methods and numbers involved and also on the types of drugs themselves.
For instance, one study that found a link between antidepressants and risk for type 2 diabetes discovered the risk almost doubled in patients using two types of drugs at the same time: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

Antidepressant users more likely to have type 2 diabetes

Researchers found a link between people who take antidepressants and type 2 diabetes, although it does not mean there is a direct causal effect.

For their systematic review, Southampton health psychologist Dr. Katharine Barnard and colleagues assessed 22 studies and three previous reviews that looked at the link between antidepressant use and risk for type 2 diabetes.
They found that overall, people on antidepressants were more likely to have type 2 diabetes.
Within that, however, the picture is somewhat "confused, with some antidepressants linked to worsening glucose control, particularly with higher doses and longer duration, others linked with improved control, and yet more with mixed results."
They note that although study quality was variable, the more recent, larger studies suggest a modest effect.
The researchers also propose that different types of antidepressants may be linked to different amounts of risk and call for long-term randomized, controlled trials to examine the effects of individual drugs.

Several 'plausible' explanations

While their review was not designed to investigate causes, the team says there could be several plausible explanations for the link. For instance, some antidepressants cause patients to put on weight, which in itself increases risk for type 2 diabetes.
But they also point out that some of the studies they reviewed found the raised risk for type 2 diabetes persisted when they took out the effect of weight gain, suggesting other factors could be involved.
Dr. Barnard says:

"Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle etc, there is something about antidepressants that appears to be an independent risk factor."

She says that in light of rising prescriptions, "this potential increased risk is worrying," and:
"Heightened alertness to the possibility of diabetes in people taking antidepressants is necessary until further research is conducted."
Co-author Richard Holt, professor in Diabetes and Endocrinology at Southampton, adds:

"While depression is an important clinical problem and antidepressants are effective treatments for this debilitating condition, clinicians need to be aware of the potential risk of diabetes, particularly when using antidepressants in higher doses or for longer duration."

He says doctors prescribing antidepressants should be aware of this raised risk for diabetes and ensure they monitor patients for the condition, as well as take steps to reduce the risk by encouraging changes to lifestyle.

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Suicide Can Be Contagious Among Teens

Suicide can be contagious, especially among teenagers, according to a new study published in the Canadian Medical Association Journal (CMAJ).

The research suggests that one person's suicide can influence another person's suicidal thoughts or behavior, and this is particularly seen among younger adolescents.

Additionally, the teens do not have to be personally associated with the suicide victim to start thinking about suicide or to attempt suicide themselves, the investigators discovered.

Dr. Ian Colman, an assistant professor at the Department of Epidemiology and Community Medicine and Canada Research Chair in Mental Health Epidemiology, said:

"When someone dies, particularly a young person, the deceased is described by their loved ones in the media and in social media in glowing, romantic terms, often mentioning how beautiful the child was.

Talk like this is common when any child dies, but it can be dangerous when talking about suicide. When other vulnerable youth are reading or hearing about this, they see the reports about how wonderful the person was and they want their loved ones to feel the same way about them."

A previous study suggested that teens are at the highest risk of attempting suicide within two years after a parent has attempted suicide or has received inpatient care because of a mental disorder.

For the current investigation, the experts gathered and analyzed data from more than 22,000 volunteers between the ages of 12 and 17.

According to the results, 12-to-13 year olds who had been exposed to suicide had a five times higher risk of contemplating suicide themselves or to say that they had attempted suicide.

After factoring in the adolescent's personal knowledge of the person who died, the scientists were surprised to see that there was nearly no difference in these statistics.

As the teenager grows older, the influence seems to decline, the researchers explained. Fourteen-to-fifteen year olds who were exposed to suicide were three times as likely to think about or attempt suicide, while those aged 16-to-17 were twice as likely.

These results have practical implications for experts in the mental health field concerned with prevention.

Dr. Colman said:

"It's clear that these results support the suicide contagion hypothesis, especially among younger adolescents.  It most certainly supports school-based interventions as opposed to high-risk interventions aimed solely at the friends of the deceased."

The report emphasizes the unfortunate consequences that may unintentionally result when the public pays too much attention to individual suicide cases.

It is critical to re-evaluate current strategies that are associated with the support and creation of mental health programs, the authors said.

A study from earlier this year indicated that most suicidal teens being treated still attempt suicide, suggesting that they are not being given the proper treatment.

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Study Suggests Link Between Untreated Depression And Response To Shingles Vaccine

Results from a new study published in Clinical Infectious Diseases suggest a link between untreated depression in older adults and decreased effectiveness of the herpes zoster, or shingles, vaccine. Older adults are known to be at risk for shingles, a painful condition caused by the reactivation of the varicella-zoster virus, and more than a million new cases occur each year in the U.S. The vaccine boosts cell-mediated immunity to the virus and can decrease the incidence and severity of the condition.

In a two-year study, led by Michael Irwin, MD, at the University of California-Los Angeles, researchers measured the immune responses to shingles vaccination among 40 subjects aged 60 or older with a major depressive disorder and compared these responses to similar levels in 52 control patients matched by age and gender. Measurements were taken at baseline, and then 6 weeks, 1 year, and 2 years after the patients received the shingles vaccine or a placebo.

Depressed patients not being treated with antidepressants (selective serotonin uptake inhibitors) had lower cell-mediated immunity to the varicella-zoster virus - and were less able to respond to the shingles vaccine - compared with patients who were not depressed or who were depressed but were receiving treatment with antidepressants, the researchers found.

The findings suggest that patients with untreated depression were "poorly protected by shingles vaccination," said Dr. Irwin. Depression treatment, on the other hand, boosted cell-mediated immunity and increased the effectiveness of the vaccine among those studied, even when the treatment did not lessen depression symptoms, the researchers found. Treating depression, noted Dr. Irwin, appeared to "normalize the immune response to the zoster vaccine" in the study.

Larger studies are needed to evaluate the possible relationship between untreated depression and the risk of shingles, the study authors noted, along with research to establish what mechanisms are responsible for patients' reduced immune response. The possible connection, however, is potentially significant: If antidepressants increase the efficacy of the shingles vaccine in those who are depressed, such treatment may have a similar effect on the immune response of depressed patients to other important vaccines, such those against influenza.

Diagnosis and treatment of depression in older adults may increase of the effectiveness of the shingles vaccine and help diminish the risk of shingles, the study authors conclude from their findings. "Efforts are also needed to identify and diagnose depressed elderly patients who might benefit from either a more potent vaccine or a multi-dose vaccination schedule," Dr. Irwin said.

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Decline In Availability And Use Of ECT, A Key Treatment For Depression

Electroconvulsive therapy (ECT) is considered the most effective treatment option for patients with severe depression who cannot find symptom relief through antidepressant medications or psychotherapy. In a new study, researchers at Butler Hospital and Bradley Hospital in Rhode Island found a sharp decline in the availability and use of ECT in general hospitals across the U.S. The findings were published online in the journal Biological Psychiatry.

The researchers analyzed data from a nationally representative survey of US general hospitals, the Nationwide Inpatient Sample (NIS), conducted annually by the Agency for Healthcare Research and Quality (AHRQ). They took information from between five and eight million patient discharge records at 1,000 hospitals nationwide between the years 1993 through 2009 and found that the annual number of hospital stays in which ECT was administered fell 43 percent over the 17 year period, from more than 1.2 million to 720,000. Researchers also found a dramatic decline in the percentage of hospitals conducting ECT, from 55 percent to 35 percent of facilities with a psychiatric unit. The percentage of inpatients with severe, recurrent major depression treated in hospitals conducting ECT fell from 71 to 45 percent. But for depressed patients treated in hospitals that conduct ECT, the proportion who received the procedure remained stable.

"The data strongly support the impression that psychiatric units in general hospitals are discontinuing use of ECT and that this is driving the decline in the number of severely depressed inpatients receiving the procedure," said Brady Case, MD, an assistant professor of psychiatry and human behavior at Brown University and director of the Health Services Research Program at Bradley Hospital. "Growing pressures to avoid the inpatient treatment costs and length of stay associated with ECT may be one factor associated with this trend. We didn't have information on provider and patient attitudes, but as facilities cease conducting ECT, we can expect that fewer clinicians and inpatients are exposed to the option, reinforcing the turn away from ECT." Researchers also note the FDA approval of new treatment alternatives, like vagus nerve stimulation and transcranial magnetic stimulation, as possible influences.

Declines in ECT availability and use were particularly dramatic in elderly patients, a group traditionally thought to benefit most from the procedure. "Decreased availability of ECT for older patients with severe depression is of major concern, since a significant proportion of this group fails to benefit from available medication treatments. In such cases, ECT can literally be a life-saving intervention," said Lawrence Price, MD, clinical and research director at Butler Hospital and professor of psychiatry and human behavior at Brown University.

The researchers also noted a key finding they observed throughout the 15-year study period: depressed inpatients from poor neighborhoods and those who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT. "Access to ECT for less affluent patients has concerned the field for some time, but these data really drive home the reality. The worry is that ECT may be part of a tiered system of psychiatric care that deprives the disadvantaged of one of our most effective treatments," according to Price.

The researchers acknowledge that a limitation of the study is its exclusion of data from freestanding psychiatric facilities. Case and his colleagues note that psychiatric hospitals less commonly offer ECT than general hospitals, possibly because the procedure requires a level of medical support more readily available in general hospitals. Because of this, and the fact that psychiatric hospitals have accounted for a declining proportion of inpatient mental health care, the researchers argue that this exclusion is unlikely to have offset the declines they observed.

The data also do not include information on outpatient ECT, but many severely ill patients are inappropriate for outpatient ECT initiation. Case concedes that while "changing pharmacologic treatment practices for depression have received an immense amount of attention, we still know very little about how and where ECT is being used, especially outside of academic medical centers."

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Depression

Everybody feels "down" or "blue" sometimes. But, if these feelings are very strong or last for most of the day nearly every day for two weeks or longer, they may be due to a medical illness called depression.

The good news is that depression can be treated. You do not have to face this problem without help.

WARNING SIGNS / SYMPTOMS OF DEPRESSION

Changes in the way you feel:

• You feel sad, hopeless, or guilty most of the time.
• You feel tired or lack energy.
• You have thoughts of suicide or death.

Changes in sleeping and eating habits:

• You sleep either too much or too little.
• Your appetite has changed. You have gained or lost weight.

Changes in daily living:

• You have lost interest and pleasure in daily activities.
• You have problems making decisions or thinking clearly.

If you have had most of these symptoms for at least two weeks, you may be suffering from depression. Talk to your doctor about whether you are depressed and what you should do about it.

The sooner you get treatment for depression, the sooner you will begin to feel better. The longer you wait, the harder depression is to treat.

Depression usually is treated with counseling, medicine, or both. Medicines for depression are not addicting or habit forming. They work for people with severe depression and may be useful for people with mild to moderate depression.

Treatment works gradually over several weeks. If you do not start to feel better after this time, tell your doctor. It may take some time to find what works best for you.

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Smoking Associated With Both Anxiety And Depression

A new study indicates that smoking is linked to anxiety with depression, as well as to anxiety alone. However, people who are depressed but not anxious smoke the same as any other smokers. These findings come from a joint study from Norwegian Institute of Public Health (NIPH), University of Bergen and King's College in London.

The link between smoking and anxiety/depression was most apparent among women and young people. Data were collected from 60 000 participants in "Health Studies in North-Troendelag" (HUNT), a study based in a county in northern Norway.

Figures from the World Health Organisation (WHO) show that 30 percent of inhabitants in the western world smoke daily. Earlier studies have found that people with mental health problems are twice as likely to smoke as the rest of the population. Injuries to physical health after smoking are well documented. It is also known that smoking is linked to other psychological problems. Anxiety and depression are the most common complaints and are often both present in people who smoke.

Anxiety and depression most common among smokers

Arnstein Mykletun is the primary author of the article "Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study" published in European Psychiatry (see link under related articles). Mykletun is linked to the Division of Mental Health at NIPH but his main position is at the University of Bergen.

Mykletun explains that the study shows the strongest correlation with smoking when the subject is both anxious and depressed, next strongest with anxiety without depression and with a marginal correlation between smoking and depression without anxiety. There was no reduction in anxiety and depression over time after smoking was given up.

About the study

- Approximately 60 000 people in the age 20 - 89 years old who took part in HUNT were included in the study (HUNT has a total of 92 000 participants).

- All participants were screened using the Hospital Anxiety and Depression Scale (HADS).

- Smoking was defined as daily use of cigarettes, cigars or a pipe.

- 29 percent of participants said they were active smokers. A similar number said that they had quit smoking while 42 per cent had previously smoked.

- 9.6 percent had anxiety, 4.9 % had depression, while 5.9 % had both, as defined by HADS.

Link to article (abstract): Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study (abstract)

http://www.fhi.no

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Five Self-Care Strategies For Depression

There's no quick fix for depression. Even if you are under medical care and taking antidepressant medication, improvement takes time.

The December issue of Mayo Clinic Women's HealthSource offers five self-care strategies that can help you feel better and reduce the risk of recurrence.

1. Keep active.

--As little as 15 to 30 minutes of physical activity most days has been shown to improve mood.

--Long-term regular exercise can help prevent recurrence.

2. Eat well. A well-balanced eating strategy will help you feel better now and later.

-- Eat more whole grains, beans and vegetables. They provide a longer-lasting energy source than processed baked goods and sugar.

-- Eat regular meals, especially breakfast. Regular meals avoid the irritability and overeating that can come from skipping meals.

-- Increase your intake of cold-water fish such as salmon, halibut, tuna and bluefish. Research indicates that the omega-3 fatty acids in these cold-water fish may help reduce symptoms of depression.

-- Avoid alcohol and caffeine, which can contribute to depression and anxiety.

3. Get adequate sleep.

-- Aim for eight hours a night, and be consistent with bedtime.

4. Control stress. Coping with depression is stressful enough, so try to limit other sources of stress.

-- Simplify your schedule and prioritize.

-- Get organized so you know where to find things you need.

-- If you need a break, take it, even if it's just a day trip or weekend getaway.

-- Recognize stress signals and slow down. Is your stomach upset? Are you forgetting things or feeling extra irritable? Take notice of your signals and do something about it.

5. Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life.

-- Recognize the importance of give and take. It's true you should give of yourself in a relationship, but it's also important to receive from others, especially when you are depressed.

-- Cultivate your spirituality. Studies have shown that believing in something larger than yourself strengthens your ability to cope with life's ups and downs.

-- Avoid negative and unhealthy connections that might bring you down.

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What Is Low Blood Pressure? What Is Hypotension?

Low blood pressure is also known as hypotension. For millions of people who suffer from hypertension (high blood pressure) hypotension may seem great. If symptoms are mild hypotension usually requires no treatment. However, it can cause serious heart disorders, fainting and also lead to neurological and endocrine disorders. If hypotension is severe key organs can become deprived of oxygen and nutrients and the body can go into shock, a life-threatening condition.

According to Medilexicon's medical dictionary, hypotension is "1. Subnormal arterial blood pressure. 2. Reduced pressure or tension of any kind."

What is blood pressure?

The heart is a muscle that pumps blood around the body continuously. Blood that is low in oxygen is pumped towards the lungs, where oxygen supplies are replenished. The heart pumps this oxygen-rich blood around the body to supply our muscles and cells. The pumping of blood generates pressure - blood pressure.

When we measure blood pressure, we gauge two different types of pressure:

• Systolic pressure - the blood pressure when the heart contracts, specifically the moment of maximum force of the contraction, which occurs when the left ventricle of the heart contracts.


• Diastolic pressure - the blood pressure between heartbeats, when the heart is resting and opening up, (dilating).

When our blood pressure is taken the doctor or nurse needs to measure both the systolic and diastolic pressures. The figures usually appear with a larger number first (systolic pressure), and then a smaller number (diastolic pressure). The figure will be followed by the abbreviation mmHg, which means millimeters of mercury.

If your blood pressure is 120 over 80 (120/80 mmHg), it means a systolic pressure of 120mmHg and a diastolic pressure of 80mmHg.

Our levels of blood pressure can fluctuate by as much as 30 or 40 mmHg during the day. It will be at its lowest point when we are asleep or resting. When we are physically active, very stressed or anxious our blood pressure rises. It is important that blood pressure is taken under similar circumstances each time so that when the readings are compared they refer to the same state of physical activity.

What is low blood pressure (hypotension)?

Anybody with a reading if 90/60 mmHg or lower is regarded as having hypotension (low blood pressure). People with low blood pressure have some protection from factors which raise blood pressure to undesirable levels. However, low blood pressure may be a sign of an underlying problem, and can cause unpleasant symptoms.

What are the symptoms of low blood pressure (hypotension)?

Many people whose blood pressure is low will experience no symptoms. If the hypotension is not severe and there are no underlying conditions no treatment is necessary.

If blood pressure is so low that the supply of blood to the brain and other vital organs is insufficient the patient will need medical attention. Severe hypotension is caused by an underlying illness or condition.

Below are the most common symptoms of hypotension:

• Blurred vision
• Cold, clammy, pale skin
• Depression
• Dizziness
• Fainting
• Fatigue
• General feeling of weakness
• Nausea
• Palpitations
• Rapid, shallow breathing
• Thirst

Orthostatic hypotension (postural hypotension)

This refers to a lowering of blood pressure after changing posture. This can occur when you stand up from a sitting or lying position, or sit up from a lying position. The low blood pressure will return to normal levels rapidly. Postural hypotension occurs more frequently as we get older.

Low blood pressure after meals (Postprandial hypotension)

Sometimes blood pressure can drop after eating, causing light-headedness, dizziness, and wooziness (faintness). This is known as postprandial hypotension. It more commonly occurs among elderly people, especially elderly people who suffer from hypertension (high blood pressure), diabetes, or Parkinson's disease.

After we eat our intestines require a significant increase in blood supply for digestion. The heart responds by beating faster while blood vessels in other parts of the body narrow (constrict) to help maintain blood pressure. When we reach old age the heart beat may not increase enough to maintain blood pressure. Also, the blood vessels that were supposed to have narrowed do not constrict sufficiently to maintain blood pressure. Consequently, blood pressure drops. If you are prone to developing postprandial hypotension you may find that the following simple steps help:

• Lie down after the meal.
• Lower the carbohydrate content of your meals.
• Eat smaller and more frequent meals - perhaps four or five small meals a day instead of 3 big ones.

What causes low blood pressure (hypotension)?

Some medications

• Alpha blockers
• Beta blockers
• Tricyclic antidepressants
• Diuretics
• Drugs for Parkinson's disease
• Sildenafil (Viagra), more so if in combination with nitroglycerine

Anesthesia

Blood pressure is usually deliberately reduced for surgery. Hypotensive anesthesia - deliberately lowering blood pressure for surgery - reduces intraoperative blood loss as well as surgical time.

Feeling faint in the toilet - urinating (micturition syncope), defecating (defecation syncope)

If you strain when urinating or having a bowel movement the vagus nerve is stimulated, causing an increase in acetylcholine levels in the body. Acetylcholine dilates the blood vessels. Dilated blood vessels bring blood pressure down which reduces blood supply to the brain. A sudden drop in blood supply to the brain can cause dizziness and fainting (syncope). Micturition syncope means feeling faint/fainting when urinating, and defecation syncope means feeling faint/fainting while having a bowel movement. In virtually all cases the problem resolves quickly and no treatment is required. Swallow syncope and cough syncope, feeling faint/fainting from swallowing or coughing are also caused by the stimulation of the vagus nerve.

Serious injuries and/or internal bleeding

If you lose a lot of blood from a serious injury or internal bleeding blood volume will drop, leading to severe and potentially dangerous hypotension. Serious burns can lead to shock and a reduction in blood pressure.

Septicemia, blood poisoning, severe infection

Virulent bacteria from an infection somewhere in the body can invade the bloodstream (septicemia). The patient can go into septic shock; a life-threatening drop in blood pressure.

Dehydration

When your body loses more water than it takes in you eventually become dehydrated. Hydration levels (levels of water in the body) do not have to drop much before you start feeling dizzy and weak - dehydration-induced weight loss of just 1% can lower blood pressure enough to cause symptoms. Dehydration can be caused by severe diarrhea, vomiting, heat, overusing diuretics, and over-exercising. If water or blood levels drop dramatically the patient can go into hypovolemic shock - the severe water/blood drop in volume means the heart cannot pump the blood properly, resulting in life-threatening hypotension.

Endocrine problems (not including diabetes)

The endocrine system is a system of glands involved in the release of hormones - examples include the thyroid gland, and the adrenal gland. The thyroid gland makes and stores hormones that help in the control of the heart rate, blood pressure, body temperature, and the rate at which food is broken down and converted into energy (part of metabolism). Low blood pressure can be caused by hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid). If the adrenal glands do not work properly (adrenal insufficiency) there is also a risk of hypotension - the adrenal glands are located just above each kidney and are chiefly responsible for regulating the stress response.

Diabetes

Damage to the nerves in the body, including those in the autonomic nervous system, is a complication of diabetes. Autonomic dysfunction makes people more susceptible to orthostatic hypotension (postural hypotension) - feeling faint when you suddenly sit up from a lying position, or stand up from a sitting/lying position.

Heart disease

Badycardia (very low heart rate), heart valve problems, heart attack and heart failure can cause very low blood pressure, mainly because the heart is unable to pump enough blood to keep the pressure up.

Pregnancy

Blood pressure usually drops during pregnancy because the circulatory system expands during gestation. Systolic pressure typically falls about 5 to 10 points, while diastolic pressure may fall by 10 to 15 points. This is a normal part of a healthy pregnancy and is rarely cause for concern. Soon after childbirth blood pressure will resume to normal levels.

Anaphylaxis (severe allergic reaction)

Some people may have a severe allergic reaction to some substances, foods, exercise, medications, latex, or insect bites. One of the symptoms could be a severe drop in blood pressure, as well as hives, itching, swollen neck and breathing difficulties.

Diet deficiency

A diet with insufficient quantities of vitamins B-12 and folate can cause anemia. Anemia often results in hypotension.

Eating disorders

Anorexia nervosa has abnormally slow heart rate and low blood pressure among its many complications. Bulimia nervosa leads to electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure - both these heart problems tend to result in serious hypotension.

How is low blood pressure (hypotension) diagnosed?

The doctor will try to establish whether there is an underlying cause. This will help decide on the best treatment. A nervous disease problem will not have the same treatment as, for example, a heart problem. The doctor may order some of the following tests:

Sphygmomanometer - to measure blood pressure

Most lay people have seen this device. It consists of an inflatable cuff that is wrapped around the upper arm. When the cuff is inflated it restricts the blood flow. A mercury or mechanical manometer measures the pressure.

A sphygmomanometer is always used together with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. For example, a manual sphygmomanometer is used together with a stethoscope.

• The cuff is placed snugly and smoothly around the upper arm, at approximately the same altitude as the heart while the patient is sitting up with the arm supported (resting on something). It is crucial that the size of the cuff is appropriate. If it is too small the reading will be inaccurately high; if it is too large the reading will be too low.


• The cuff is inflated until the artery is completely obstructed (occluded).


• The nurse, doctor, or whoever is doing the examination listens with a stethoscope to the brachial artery at the elbow and slowly releases the cuff's pressure (deflates it).


• As the cuffs pressure falls the examiner will hear a whooshing sound or a pounding sound when blood flow starts again.


• The pressure at the point when the sound began is noted down and recorded as the systolic blood pressure.


• The cuff is deflated further until no sound can be heard. At this point the examiner notes down and records the diastolic blood pressure.

With a digital sphygmomanometer everything is done with electrical sensors.

To find out whether the problem is a sustained one, diagnosis confirmation requires more than one reading.

Blood tests

These may indicate whether there are any problems with high sugar (hyperglycemia) or low sugar (hypoglycemia) levels. A low red blood cell count would indicate anemia.

ECG (electrocardiogram)

This device detects heart rhythm irregularities, problems with blood supply to heart muscles, as well as any structural abnormalities in the heart. It can also determine whether the patient ever had a heart attack, or is even having one while the test is underway.

Holter monitor

This is a sort of portable ECG device. If the ECG does not detect any problems the doctor may want to monitor the patient's heart rhythm for longer, perhaps for a 24 hour period. The patient wears the Holter monitor which records the heart's electrical activity as he/she goes about his/her daily business. The device is worn in a pouch either around the waist or neck. The doctor may ask the patient to record their activities and any symptoms they may feel into a diary. The details of the diary, which should include specific times, will be compared to the Holter's records.

Echocardiogram

This device uses ultrasound waves which show the heart in motion. The doctor will be able to detect problems, such as defective heart valves.

Exercise stress test

An exercise stress test sometimes reveals problems that are not apparent when the body is resting. The stress test assesses how the body's cardiovascular system responds to increased physical activity. The test monitors the electrical activity of the heart, as well as the patient's blood pressure during exercise. Imaging scans of the heart's blood supply might be done at the same time.

Valsalva maneuver

This tests the functioning of the autonomic nervous system. After several cycles of a type of deep breathing it analyses the heart rate and blood pressure. The patient takes a deep breath and then tries to blow out with the mouth closed and the nose blocked (so no air can get out).

Tilt-table test

If you have postural hypotension (low blood pressure when standing from a sitting/lying position), or neurally mediated hypotension (low blood pressure from faulty brain signals) and neither the ECG nor the Holter revealed anything, a tilt-table test may be performed. This monitors blood pressure, heart rhythm and heart rate while the patient is moved from a lying down to an upright position. Our reflexes cause the heart rate and blood pressure to change when moved to an upright position - this is to make sure the brain gets an adequate supply of blood. If the reflexes are inadequate, they could explain some of the symptoms, such as the fainting spells.

What is the treatment for low blood pressure (hypotension)?

People with hypotension and either no symptoms or very mild ones do not require treatment. The National Health Service (NHS), UK, says that a very small percentage of patients who are diagnosed with low blood pressure by their GPs (general practitioners, primary care physicians) are prescribed medications.

• Medication for low blood pressure
  
  Some elderly patients who experience symptoms when they suddenly stand up (postural hypotension) may be prescribed medication to narrow the arteries. Fludrocortisones helps boost blood volume. Midodrine also helps boost blood pressure levels.


• Low blood pressure caused by medications
  
  If the doctor believes the low blood pressure is being caused by a medication, the dose may be altered. If possible, the doctor may prescribe another medication.
  
  If the patient is on a blood pressure lowering drug, such as doxazosin, or an alpha blocker and becomes dizzy or faints when standing up, the doctor will need to find out whether it is being caused by a drop in blood pressure. If it is, the medication will need to be changed.


• Underlying illnesses or conditions
  
  If the General Practitioner believes the hypotension is being caused by an underlying condition or illness, such as adrenal gland failure, a thyroid disorder, a nerve condition or a heart condition, the patient will most likely be referred to a specialist.


• Adrenal gland failure
  
  This is treated by replacing the missing hormone, aldosterone.


• A nerve condition
  
  This is usually harder to treat. The patient may be given medication to stimulate the nervous system.


• Salt and fluids
  
  Increasing salt intake may improve the symptoms of hypotension, especially for those with postural hypotension. This can be done either by taking salt tablets or adding more salt to food. It is important to make sure your fluid intake is adequate - ask your doctor how much fluid (water) you should ideally consume each day. Fluids increase blood volume and prevent dehydration - both have an impact on blood pressure levels.


• Compression stockings
  
  These help stimulate circulation.

What are the complications of hypotension (low blood pressure)?

• Orthostatic hypotension (postural hypotension)
  
  In most cases becoming slightly dizzy or woozy when you stand up is just a nuisance, and nothing more. However, if it causes a severe drop in blood pressure there is a risk of injury if you faint and fall down. If sitting and then standing and then sitting, etc., cause large fluctuations in blood pressure there is also a higher risk of developing stroke, dementia, and other brain disorders.


• Severe hypotension
  
  Untreated severe low blood pressure can in the long-term damage the organs, including the heart and the brain.

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What Is Depression? What Causes Depression?

Feeling sad, or what we may call "depressed", happens to all of us. The sensation usually passes after a while. However, a person with a depressive disorder - clinical depression - finds that his state interferes with his daily life. His normal functioning is undermined to such an extent that both he and those who care about him are affected by it.

According to MediLexicon's Medical Dictionary, depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."

What are the different forms of depression?

There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.

• Major depressive disorder (major depression)
  
  Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences.


• Dysthymic disorder (dysthymia)
  
  Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.
  
  A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed.


• Psychotic depression
  
  When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.


• Postpartum depression (postnatal depression)
  
  Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND. Experts believe that about 10% to 15% of all women experience PND after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.


• SAD (seasonal affective disorder)
  
  SAD is much more common the further from the equator you go. In countries far from the equator the end of summer means the beginning of less sunlight and more dark hours. A person who develops a depressive illness during the winter months might have SAD. The symptoms go away during spring and/or summer. In Scandinavia, where winter can be very dark for many months, patients commonly undergo light therapy - they sit in front of a special light. Light therapy works for about half of all SAD patients. In addition to light therapy, some people may need antidepressants, psychotherapy, or both. Light therapy is becoming more popular in other northern countries, such as Canada and the United Kingdom.


• Bipolar disorder (manic-depressive illness)
  
  Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.

What are the signs and symptoms of depression?

Depression is not uniform. Signs and symptoms may be experienced by some sufferers and not by others. How severe the symptoms are, and how long they last depends on the individual person and his illness. Below is a list of the most common symptoms:

• A constant feeling of sadness, anxiety, and emptiness
• A general feeling of pessimism sets in (the glass is always half empty)
• The person feels hopeless
• Individuals can feel restless
• The sufferer may experience irritability
• Patients may lose interest in activities or hobbies they once enjoyed
• He/she may lose interest in sex
• Levels of energy feel lower, fatigue sets in
• Many people with a depressive illness find it hard to concentrate, remember details, and make decisions
• Sleep patterns are disturbed - the person may sleep too little or too much
• Eating habits may change - he/she may either eat too much or have no appetite
• Suicidal thoughts may occur - some may act on those thoughts
• The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These problems do not get better with treatment.

Some illnesses accompany, precede, or cause depression

Anxiety disorders, such as PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia, generalized anxiety disorder and panic disorder often accompany depression.

People who are dependent on alcohol or narcotics have a significantly higher chance of also having depression.

Depression is much more common for people who suffer from HIV/AIDS, heart disease, stroke cancer, diabetes, Parkinson's disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve.

What causes depression?

We are still not sure what causes depression. Experts say depression is caused by a combination of factors, such as the person's genes, his biochemical environment, his personal experience and psychological factors.

MRI (magnetic resonance imaging) has shown that the brain of a person with depression looks different, compared to the brain of a person who has never had depression. The areas of the brain that deal with thinking, sleep, mood, appetite and behavior do not appear to function normally. There are also indications that neurotransmitters appear to be out of balance. Neurotransmitters are chemicals that our brain cells use to communicate. However, imaging technology has not revealed why the depression happened.

We know that if there is depression in the family a person's chances of developing depression are higher. This suggests there is a genetic link. According to geneticists, depression risk is influenced by multiple genes acting together with environmental and others factors.

An awful experience can trigger a depressive illness. For example, the loss of a family member, a difficult relationship, physical sexual abuse.

What is the treatment for depression?

Depression is highly treatable - even in its most severe forms. The sooner a person is treated the more effective that treatment will be. Studies have also shown that prompt treatment reduces significantly the likelihood of recurrence.

As some medications and medical conditions can cause the same symptoms as depression, you need to get your doctor to rule out these possibilities before conducting a physical examination. You will also have an interview and lab tests. When your doctor, usually a GP (general practitioner) at this point, has ruled out a medical condition or pharmacological cause, he will either carry out a psychological evaluation or refer you to a mental health specialist.

The mental health specialist should carry out a comprehensive diagnostic evaluation. You will be asked whether there is any family history of depression, what your symptoms are and how long they have existed, how severe your symptoms are. You will also be asked whether you consume alcohol or drugs, and whether you have had any suicidal thoughts.

If you are diagnosed with some form of depressive illness, you will be offered treatment. Depression can be treated with a number of methods; the most common are drugs and/or psychotherapy.

There is evidence supporting the idea that exercise can help patients with depression, particularly if they have or are at high risk of developing other conditions such as obesity, cardiovascular disease or diabetes, which can often be the case.

Medication for depression

The aim of an antidepressant is to stabilize and normalize the neurotransmitters in our brain (naturally occurring brain chemicals), such as serotonin, dopamine, and norepeniphrine. According to various studies, these neurotransmitters play a vital role in regulating mood. We know they regulate mood, but we are not exactly sure how they do it.

SSRIs (selective serotonin reuptake inhibitors) are the newest antidepressants; they are also the most popular. Prozac (fluoxetine), Celexa (citalopram), and Zoloft (sertraline) are all SSRIs.

SNRIs (norepinephrine reuptake inhibitors) are similar to SSRIs. Effexor (venlafaxine) and Cymbalta (duloxetine) are SNRIs.

SSRIs and SNRIs are more popular today than older types of antidepressants, mainly because they have fewer side-effects. MAOIs (monoamine oxidase inhibitors) and tricyclics are examples of older antidepressants. Nevertheless, modern antidepressants do affect some people with undesirable side-effects. For people who experience high levels of unpleasant side effects with SSRIs or SNRIs, tricyclics or MAOIs may be a better option.

If you are taking MAOIs you have to be careful with your diet and other medications. MAOIs have potentially serious interactions with some foods and drugs. Cheeses, wines and pickles have high levels of tyramine, which interact with MAOIs - so they must be avoided. Some decongestants also have tyramine in them. When a MAOI interacts with tyramine the patient may experience a significant rise in blood pressure, which in turn increases the risk of stroke. If a doctor prescribes an MAOI make sure you receive a comprehensive list of foods, medicines and substances you should avoid.

In the majority of cases, the patient will not notice any really significant benefit from an antidepressant until he has been taking it for a few weeks. It is important to continue taking them for this reason. Make sure you take them according to your doctor's instructions. Even if you feel better, do not stop the medication unless your doctor tells you to. Not only do antidepressants help to make you feel better, they also significantly reduce your chances of having a recurrence or relapse.

Under a doctor's supervision, if you do come off the medicine it will usually be gradually. In most cases, your body needs time to adjust to the change. Even though antidepressant are said not to be addictive, if you stop taking them abruptly you may experience very unpleasant withdrawal symptoms. Many people who suffer from chronic and recurrent depression continue taking medications for an indefinite period.

If you find one drug does not work after a few weeks tell your doctor and see if he can get you onto another one. Research has shown that treatment is much more successful if a patient switches from a drug that does not seem to be working to another one.

What are the side effects of antidepressants?

Most people who experience side effects will find they are mild and short-lived. It is rare for a patient to have long-term effects, but there are cases. Any unusual reaction you experience should be reported to your doctor straight away.

Here is a list of the most common side effects experienced by some patients who take SNRIs or SSRIs:

• Headache, in the beginning. After a while it will go away.
• Nausea. This also goes away after a while.
• Insomnia. This may go away after a few weeks. In some cases a reduction of dosage may be necessary.
• Feeling jittery (agitation).
• Men may experience erectile dysfunction, delayed ejaculation.
• Both men and women may have lower libido and find it harder to achieve orgasm.

Here is a list of some side effects experienced by some patients who take tricyclic antidepressants:

• Dry mouth.
• Constipation.
• Emptying bladder may be harder, the urine stream may be weaker. A man with an enlarged prostate may be more affected. If it is hard to urinate tell your doctor.
• Men may experience erectile dysfunction, delayed ejaculation.
• Both men and women may have lower libido and find it harder to achieve orgasm.
• Vision may be blurred at first. This usually gets better.
• Daytime drowsiness at first. This usually goes away after a while. If you do become drowsy do not drive or operate heavy machinery.

In the USA in 2005 the FDA made drug makers adopt a 'black box' warning label on all antidepressant warning about the possibility of suicidal thoughts or attempts at suicide by children and adolescents who take an antidepressant. A review of trials involving over four thousand children revealed that 4% of children and adolescents who took antidepressants thought about or attempted suicide, compared to 2% of those on a placebo (a dummy drug). However, nobody did commit suicide. The warning also said that those taking antidepressants should be watched closely by their doctors during the first weeks of treatment. The warning asks health care professionals to look out for warning signs, such as worsening depression, suicidal thinking or behavior, or any changes in behavior which are out of the ordinary, such as sleeplessness, agitation, or withdrawal from normal social situations. The warning also states that family members and caregivers should also be told that close monitoring is needed, and to report any changes to the doctor.

The majority of health authorities and experts throughout the world believe that the benefits of taking antidepressants for treating major depression and anxiety disorder among children and adolescents outweigh the risks.

St. John's Wort for treating depression

St. John's Wort is a plant that grows in the wild. It is bushy and has yellow flowers. It is also known by its scientific Latin name Hypericum perforatum. It has been used for hundreds of years in Europe for the treatment of mild to moderate depression, and has become popular in other parts of the world. Some studies have shown that St. John's wort might be as effective as antidepressants in treating major depression ("St. John's Wort Helps Some Patients With Major Depression"). However, it may also act unfavorably if the patient is taking some other medications (St John's Wort Undermines Effectiveness of Anticancer Medication).

Psychotherapy for treating depression

Psychotherapy has been shown to help people with many forms of depression. Psychotherapy is carried out by a trained psychotherapist. It helps the patient with problems of living. The aim of psychotherapy is to "increase the individual's sense of wellbeing and reduce their subjective sense of discomfort." (Wikipedia). Psychotherapy is also known as 'talk therapy'.

The psychotherapist aims to improve the mental health of the patient (client) by employing a range of techniques based on experiential relationship building, dialogue, communications and behavior change.

Depending on the needs of the patient, the treatment may last from ten to 20 weeks, or for much longer. There are two main types of psychotherapy:

• Cognitive-behavioral therapy (CBT) - helps the patient alter his negative way of thinking and behaving. These negative styles may be contributing to the depression.


• Interpersonal therapy (IPT) - helps the patient through uneasy personal relationships that could be exacerbating the depression.

The majority of experts say that for a patient with mild to moderate depression psychotherapy may be all that is needed. However, for those with major depression, a combination of medication and psychotherapy is usually more effective. According to various studies, adolescents respond better to a combination of medication and psychotherapy.

Electroconvulsive therapy (ECT) for the treatment of depression

There are some patients who do not improve with medication, psychotherapy, or a combination of both. ECT, a term which replaced 'shock therapy' is sometimes useful for treatment-resistant depression. ECT has improved greatly over the years and does provide significant benefits for some patients. Side effects, such as memory loss, confusion and disorientation generally go away not long after treatment is administered.

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